Nurse - Claims Officer - Tpa

A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company. - Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information. - In addition, a processor must keep meticulous records of claims and follow up on lapsed cases. - Medical claims processors...

Has wide experience in Health Insurance Claims, worked with Network and overall claims in insurance or TPA companies in the UAE.Paramedical / Medical degree holder and with Insurance exposure.Managerial role. leading a team and with medical knowledge and background.Knowledgeable with Porfolio Management.Job Types: Full-time, PermanentPay: AED20,000.00 -...

We are immediately hiring a Medical Claims Officer for our TPA Almadallah Healthcare Must have 5+ years experience in Medical Insurance/TPA experience as a Medical Claims Officer Qualification-MBBS (mandatory) Salary-8000-9000 AED/month Preference for immediate joiners Pay: AED8,000.00 - AED9,000.00 per month Application Question(s): - Do you have...

A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company. - Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information. - In addition, a processor must keep meticulous records of claims and follow up on lapsed cases. - Medical claims processors...

Immediately hiring Medical Claims Processor Must have 1-3 years experience in TPA/Insurance Medical Coding experience is an advantage Salary-4600 AED/month Pay: AED4,600.00 per month Ability to commute/relocate: - Dubai: Reliably commute or planning to relocate before starting work (required) Application Question(s): - Do you have Nursing/Pharmacy...

RESPONSIBILITIES AND DUTIESResearch and follow up on Medical Treatment patterns and conduct utilization reviews for Beneficiaries (Policyholders) & Medical Network providers, Quality control by:§ Being available (On call) 24 hours a day for Claim Centre Officers queries relating to in-patient claims.§ Assess day-care and in-patient cases as per medical...

Participates in complex audits, third party audits, ad-hoc projects and assignments as defined by the Quality Auditor Team Manager. - Performs root cause analysis on audit findings to understand why the findings occurred. - Agrees suitable action plans to remove root causes and prevent findings from recurring. - Monitors performance trends and agrees...

MAIN DUTIES/ RESPONSIBILITIES - Build extensive knowledge of the business operation in order to analyze current work procedures and practices. - Utilize Agile methodologies to collaborate with business and technology partners to identify problems and deliver system enhancements. - Participate in refinement sessions to ensure technology solutions meet...

**SUMMARY** The Claims Management - Assessor will provide quality service to clients by promptly and effectively assessing and processing claims and approval according to operations set standards for direct type of claims**.** **MAIN TASKS** Evaluates claims with regards to eligibility and medical necessity if required. Ensures that insurance claims...

**1.** **JOB PURPOSE** - The Jobholder serves customers\members by determining requirements, answering inquiries, resolving problems, fulfilling requests, and maintaining database. He / She should provide accurate and information to customers. **2.** **RESPONSIBILITIES AND DUTIES** - Should escalate all discrepancies encountered in TOB (Table of benefits),...

**Summary** The Precertification Officer is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers with high efficiency and within the agreed turnaround time to maintain the team KPIs. **Main Tasks** - Assesses approval of medical approvals as well as policy...

**Summary** The Claims officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. **Main Tasks** - Evaluates medical claims from the technical and medical perspectives as per policy terms and conditions. - Checks particular treatment plan is necessary for the...

**1.** **JOB PURPOSE** - The Jobholder serves customers\members by determining requirements, answering inquiries, resolving problems, fulfilling requests, and maintaining database. He / She should provide accurate and information to customers. **2.** **RESPONSIBILITIES AND DUTIES** - Should escalate all discrepancies encountered in TOB (Table of benefits),...

**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...

**Summary** The Medical Claims - Assessor will provide quality service to clients by promptly and effectively assessing and processing claims and approval according to operations set standards. **Main Tasks** - Manages routine daily claims administration work. - Coordinates work flow & meet deadlines. - Evaluates claims with regards to eligibility. -...

Assesses approval of medical approvals as well as policy use.Check particular treatment plan is necessary for the patient.Inputs verbal and written claims approvals regularly.Decide approvals as per policy conditions.Assess high-cost claims and provide decisions on high-cost and complicated cases.Provide clear feedback on queries from call Centre...

We are immediately hiring Medical Claims Processor for insurance TPA - CPT coding system and agreed tariff. - Communicate any of the diagnostic and treatment data to payers and plan to assist patients in obtaining benefits. - Facilitate analysis of an insured member to improve care, delivery, and efficiency of operations to contain costs. - Accurately post...

**1.** **JOB PURPOSE** The Job holder responsibility is broad and general role that will get involved in a range of policy management activities, with the view to specialize as the role evolves. Policy Validation Support Officer will support the Middle East region, giving great exposure to a range of products and business units. You are expected to help...

Ensure that the details of the Pre Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules. - Evaluate the Pre Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior...

Medical Claims Assessor - Inpatient Precert Medical Claims Assessor - Inpatient Precert3+ years medical practical experience (reputable insurance provider, broker or a TPA experience a plus).Knowledge of overall insurance industry practices is a plus.Legally permitted to work in the country of operations.Physically fit to carry out duties.Fluency in MS...