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Vacancy
1 Vacancy
Job Description
Roles & Responsibilities
Key responsibilities/What you do:
- Assesses approval of medical approvals as well as policy use.
- Channels Medical Claims officers in handling difficult medical cases and optimize the quality and quantity output.
- Monitors daily output on the number of case done and decrease in number of errors committed.
- Provides second opinion for cases where there is doubt in treatment plan.
- Decides approvals as per policy conditions.
- Assess high-cost claims and provide decision on high cost and complicated cases.
- Provides clear feedback on queries from call Centre team.
- Provides clients an understanding of any declined medical claims.
- Ability to leverage AI for optimizing workflow and reducing errors in claims management.
- Manages routine daily claims administration work.
- Coordinates workflow & meet deadlines.
- Provides on job training to team members, as necessary.
Desired Candidate Profile
Key requirements/What you bring:
- Bachelors of Phramacy.
- 2+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).
- Physically fit to carry out duties.
- Legally permitted to work in the country of operations.
- Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
Company Industry
- Insurance
Department / Functional Area
- Insurance
- Underwriting
- Surveying
- Actuary
Keywords
- Senior Medical Claims Officer
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