Job closed
Ref: OP723-01
Job description / Role
- Evaluate medical claims (Network & Direct), provide authorizations for insured members (in-patient & outpatient) and handle calls relating to medical cases efficiently.
- Assess risk exposure of members in line with medical underwriting policies.
- Manage queries from providers, Insurance Companies and insured members relating to claims processing, evaluation and administration.
- Provide medical guidance to the Claims Department staff and assistance in ICD coding.
- Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction.
- Client Management / attending hospital visits to investigate on claims in order to minimize fraud and abuse.
- Compile data and prepare monthly statistical reports to monitor departmental performance and medical trends.
Requirements
- University degree in MBBS.
- Fresh Graduates or candidates with 1- 2 years of experience in Medical Claims Evaluation preferably from TPA / MSO organization in Insurance sector.
- Knowledge of health insurance would be an advantage.
- Effective interpersonal and communication skills to manage client expectations, both internal and external with fluency in business English (written and spoken); Arabic would be an advantage
- Team player, motivated, dependable and open-minded
- Assertive, reliable and has the ability to work under strict deadlines
- Cross-cultural competence, willingness to work on shift basis
About the Company
MedNet is a managed care service provider of quality solutions that meet an individual's long-term healthcare needs and offers financial protection against unforeseen health crisis and expenses. MedNet is dedicated to build long-term relationships with customers (insured members, insurance companies and other entities which require managed care services) by facilitating access to high quality and affordable managed care services.