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Objective: The job holder will be responsible for reviewing, auditing medical claims, evaluate pending claims, reconciliation & handling Pre-authorization requests with assuring excellent customer service.
External Communication: Customers, Intermediaries and Health Care Providers - For resolving queries / issues, managing relationships, pre-authorizations and conveying information.
Main Responsibilities : Coordinate with providers to make procedures more cost effective.
Assist in managing Pre-authorization business to optimize cost efficiencies and subject to medical & policy eligibility.
Assist in implementation of medical claims processes, reconciliations protocols and to communicate & clarify to clients, providers & intermediaries.
Minimize fraud by conduction of provider visits, second opinions and profiles. Maintain documentation process in relation to providers.
Review and audit medical claims and evaluate pending claims
Reporting to : AVP - Medical Claims - Health Department
Subordinates : Officer Medical Processing
Other interactions : Clients, providers & intermediaries
Number required : 2
Duration : Permanent
Desired start date : Immediately
Probation : 6 Months
Working hours : 5 days / week 8 hrs / day
University Qualifications : MBBS/ MBChB or above
Other certifications : Insurance qualification an added advantage.
Previous experience : Medical Doctor, any department
Specialist knowledge : Strong Medical Knowledge
Other Skills : Knowledge of MS Office
Strong Analytical ability with Initiative and
Good Interpersonal and Communication skills
Strong Problem solving and decision making capabilities
Very good Written & verbal communication skills in English
Ideal Age Range : 25 - 40
Gender Preference : Male
Nationality Preference : Any
Language Skills : English
Current Residence : Dubai, UAE
About the Company
A leading Insurance Company in the UAE.