Medical Claims Supervisor
6 months ago
**Job Designation **:Medical Claims Supervisor
**Job Location** : NGI- Head Office
**Responsibilities**
- Responsible for the screening of claims to ensure cost containment, medical necessity, and check for fraudulent activity.
- Screen all claims (e-claims and paper claims) in a proper and aggressive manner for all hospitals, clinics, and pharmacies for processors.
- Check authorization of claims, policy details and wordings, coverage limit, necessity of treatment and CPT coding at time of screening.
- Managing PBM issues.
- Screening of resubmission claims.
- Attending to reconciliation with providers.
- Attending to reimbursement claims Healthnet and Neuron.
- Escalate complicated and suspected fraud cases to higher management to minimize fraudulent claims.
- Coordinate with Network department to ensure prices are in balance as per services and standards
- Attend to and provide exemplary customer service to any incoming calls from customers, providers or business development executives
- Any additional tasks assigned by manager, as per changing business need.
- Able to work in shifts, especially weekends.
**Qualifications**:
- Educational Attainment / Certifications - MBBS or equivalent qualification
- Years of experience
- Minimum 2-3 year in TPA / Payer / Provider
- Industry Preferred
- Insurance
- medical claims and preauthorization.
**Skills Required-**
Ø UpToDate on DRG and other UAE billing rules
Ø Knowledge in Medical Coding
Ø Advanced Excel
Ability to commute/relocate:
- Dubai: Reliably commute or planning to relocate before starting work (required)
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