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Medical Consultant-Medical Authorization IP

Neuron LLC

Posted on September 9, 2017

2 - 4 years Dubai - United Arab Emirates

MBBS(Medicine). Any Nationality

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Job Description

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Job Purpose:
The job holder will be responsible for handling Pre-authorization requests with assuring excellent customer service. Provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of the cases.
Roles and Responsibilities
• Answer all incoming calls related to Inpatient authorizations following the Company guidelines and protocols. In case of call queues handle OP calls as well
• Reviews case records and reports, collects and analyzes data, evaluates client s medical status and defines needs and problems in order to provide proactive case management services
• Handle incoming client/provider emails for ongoing/escalated IP cases
• Facilitate and complete the administrative and demographic portion of the Pre-authorization screen module for each request received from the provider/ clients / members
• Handles escalated calls from Executives of the Medical Authorization OP and IP team that require an intervention and ensure a resolution is achieved.
• Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by various insurance policies
• Work the Case Managers and Sr. Medical Authorization Consultants who in turn will liaise with medical providers and suggest cost effective treatment alternatives, when appropriate.
ORGANIZATIONAL DUTIES
• Ensure Service Level Agreements (SLA) of the client is met for based on the contractual agreement.
• Maintain a good knowledge of service provided by Neuron, including Medical insurance policies and the network of hospitals, clinics and pharmacies provided
• Continuously strive to improve the processes and ensure high level of customer satisfaction and meet all the service level agreements set by our clients and the company.
• Comply with established Best Practices
Qualifications:
• Graduate Medical Qualification (MBBS Doctor)
• Familiarity with medical terminologies
• Excellent command over English (both verbal and written)
• Strong Customer Service Skills
• Ability to work on your own initiative and as part of a team
• Ability to prioritize work
• Problem solving skills and ability to generate solutions
• Prior experience in Insurance industry preferably TPA


Insurance

Keywords

Claims Diagnostics TPA English Administration Medical insurance Policies Customer service Module Management services

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