Health Insurance Processor
5 days ago
Role Summary:
Daman - National Health Insurance Company is seeking a skilled Health Insurance Processor to join our team. In this role, you will be responsible for reviewing and processing dental claims according to established guidelines and procedures.
Your primary responsibility will be to evaluate medical necessity and consistency of diagnosis, procedures and drug codes and descriptions stated on dental claims, according to accepted dental coding rules and guidelines.
You will also process (re-)submission dental claims according to expected daily target, quality, and other KPIs. Ensuring accurate application of contractual prices/discounts, schedule & correct allocation of benefits, collection of deductibles & co-payments, observance of policy limits, and adherence to claim submission protocols are also key responsibilities.
Responsibilities:
- Evaluate medical necessity and consistency of diagnosis, procedures and drug codes and descriptions stated on dental claims, according to accepted dental coding rules and guidelines.
- Process (re-)submission dental claims according to expected daily target, quality, and other KPIs.
- Ensure accurate application of contractual prices/discounts, schedule & correct allocation of benefits, collection of deductibles & co-payments, observance of policy limits, and adherence to claim submission protocols.
- Contribute to developing, updating and implementing guidelines for evaluation & processing of Dental claims, and policies, procedures and work-instructions related to Dental claims review and processing.
- Escalate dental claims related issues to the Supervisor, Dental Review.
- Deliver high quality customer service and respect medical and work ethics at all times.
- Consistently, efficiently & effectively work on achieving daily target quality benchmarks & other KPIs.
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