The incumbent will be responsible for the supervisory activities in addition to the execution of the tasks and activities pertaining to the Claims Department as assigned from time to time.
The position shall ensure meeting the relevant key performance indicators identified for the particular executive at the beginning of the year and reviewed as and when required
A proper understanding of the Company policies, processes and procedures, regulatory and compliance requirements with respect to Claims activities is required, and need to be adhered to consistently.
Duties and Responsibilities
Responsible for the continuous follow-up with TPA for maintaining the TAT for processing Reimbursement claims and escalate as required to the concerned
Handling Client/ broker queries related to the policy servicing, including but not limited to reimbursement claim updates, general queries and pending pre-authorization status.
Co-ordinating with an internal team of doctors in relation to pre-authorization
Informing broker/client on claim procedure and guidelines.
To follow up with related departments for claim settlements and to ensure that the settlements are released as per agreed channel with various clients (cheques/ bank transfers)
Involved in the generation of travel/medical certificates for specific clients/ Brokers as assigned
Being a privileged client always ensuring that all quires being resolved in a timely manner.
Highlight the service issues to the concerned team member and work for the resolution of the same.
Report to the Department head on the progress of the team and the efficiency of the TPA deliverables on a regular basis
Assisting broker/client and off-shore team in requirements of addition/deletions/corrections.
Assisting our internal invoicing team to resolve the endorsement related quires
Updating brokers diligently on requirements from regulatory bodies and internal compliance requirements.
Resolving complex queries related to addition and deletions and ensuring all transactions are in the scope of compliance.
Training our off-shore team on production related works, regulatory guideline updates, client-specific updates.
Quick tips to boost production and explaining the reason for errors and ways to avoid them.
Updating client specific guidelines in claim processing and providing training on the same.
An Indian nationality with MBBS Degree with current experience of handling medical claims in any Insurance Company/TPA is preferred for this position.
Interested candidates send CV to firstname.lastname@example.org
Offerd Salary950-1000 KD
Career LevelMid Career