·Evaluates and processes claims in accordance with insurance policy terms and conditions, company policies and procedures according to productivity and quality standards.
·Ensures that targets are met for department turnaround time, quality and productivity.
·Identify and report back any type of claims observation or issues that may affect the process.
·Collect and analyze claims data to identify and resolve errors, delayed claims, and processing issues.
·Providing recommendations to take steps to improve the claims processing quality standards and productivity.
·Analyze reports from the administrative software for provider and member utilization trends and identification of areas requiring further management.
·Support the Team Leader / Manager in implementation of quality assurance programs in order to maintain standards of quality and minimize fraudulent cases.
·Handling medical related call queries.
·Maintain confidentiality with regard to the information being processed, stored or accessed.
·Completes other projects and duties as assigned.
Education, Experience and Form Qualifications
·Health Science Degree (Nursing / Parmacist)
·Minimum 3 years of experience in Medical Claims Processing.
·Reading through doctors’ reports.
·Previous insurance or TPA experience is a must.
·Coding knowledge is preferred.
·Experience in dealing with insurers.
·The ability to manage clients, distribution teams, and insurers.
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