الوصف الوظيفي
Claim Notification, registration in system and acknowledgment to customer.
Claims documentation requisition, review, and follow-up with customer on missing document (if any)
Process claims as per the guidelines and follow the claim process.
Forward the claim to the reporting manager for the approval. Once Approved follow with the concern department for the payment.
Keep the claim files with proper archiving and forward the file whenever requested.
Sample Auditing of approved claims from the TPA before making payments that to be vigilant and if any claims come across which was approved against the policy terms escalate to the reporting manager.
Review all pre-approval request received from TPA/Providers as per the protocol of the service and forward to claims manager.
To adhere with External and Internal SLA’s.
Regular follow-up with the customer and update on the claims till the payment.
Resolve issues and complaints from both TPA/hospitals and clients to facilitate the services.
Explain Policy terms and the actual application of exclusions to both the providers and clients.
Review regularly on outstanding claims.
Prepare OCR for Medical claims and forward to claims manager for his review and approval.
Conduct analysis
Follow up for troubleshooting in system and with IT or underwriting department for policy documentation.
المهارات
Bachelor’s in medicine/Pharmacy/Surgery is mandatory.
Having a Minimum Experience of 2 years in Medical Sciences.
Working Experience in Medical or in Insurance Co/TPA as an advantage.
Bilingual as an advantage
تفاصيل الوظيفة
منطقة الوظيفة الكويت
قطاع الشركة خدمات الدعم الإداري
طبيعة عمل الشركة صاحب عمل (القطاع الخاص)
الدور الوظيفي الطب والرعاية الصحية والتمريض
نوع التوظيف غير محدد
الراتب الشهري غير محدد
عدد الوظائف الشاغرة غير محدد
المرشح المفضل
المستوى المهني متوسط الخبرة
عدد سنوات الخبرة الحد الأدنى: 2 الحد الأقصى: 5
منطقة الإقامة الكويت
الجنسية الأردن; الإمارات العربية المتحدة; البحرين; الجزائر; السودان; الصومال; العراق; الكويت; المغرب; المملكة العربية السعودية; اليمن; تونس; جزر القمر; جيبوتى; سوريا; عمان; فلسطين; قطر; لبنان; ليبيا; مصر; موريتانيا
الشهادة بكالوريوس/ دبلوم عالي
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