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Medical Claims Executive
3 weeks ago
Your Role: Medical Claims Executive
- Evaluate claims (Network & Direct), provide authorizations for insured members (in-patient & outpatient) and handle calls relating to medical cases efficiently.
- Managing all the members approval/claims and following up with insurance companies/TPAs to get approval within the TAT.
- Assisting our clients for reimbursement claims processes & network related issues.
- Assess risk exposure of members in line with medical underwriting policies.
- Manage queries from providers, Insurance Companies and insured members relating to pre-approval decisions, evaluation and administration.
- Provide medical guidance to the Department staff.
- Deliver excellent customer service to 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.
- Orientations for newly added clients and help them to understand table of benefit.
Your Profile:
- Medical Degree (MBBS or equivalent) from a school recognized by the WHO.
- 1-2 years of experience in Medical Claims Evaluation preferably from insurance broker
- Industry knowledge related to local healthcare services system.
- Good interpersonal and negotiation skills
- Excellent written and verbal communication skills
- Strong leadership, planning and organizational skills
- Analytical and problem-solving skills
- Ability to handle stress
**Job Types**: Full-time, Permanent
**Salary**: AED3,500.00 - AED5,000.00 per month
**Education**:
- Bachelor's (preferred)
**Experience**:
- Medical Insurance Claim: 1 year (required)
**Language**:
- English, Hindi (preferred)
**Speak with the employer**
+91 8296098447
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