Employment:
Full Time
Job responsibilities:
• To issue online and verbal authorizations based upon member coverage & medical justification.
• To assist queries from providers and payers via phone calls or e-mails
• To maintain files for authorizations and other reports.
• Assessing and processing claims in line with the policy coverage and medical necessity.
• Be fully versed with medical insurance policies for various groups / beneficiaries.
• Able to accurately assess eligibility within the UAE (HAAD and DHA) guidelines as well as policy boundaries.
• Monitoring and maintaining the claims processing and adjudicating cycle in operational software system as per the defined terms and policy of the organization.
• Establishing strategies and implementing effective parameters for solving all possible queries within the team.
• Taking a lead role in assuring that the assigned tasks to the team are completed within the allocated time frame.
• Ensures the proper communication and implementation of new formats, training and processing rules.
• Entering and processing/ adjudicating claims in operational software system as per the terms and policy of the organization.
Candidate’s Qualification:
• University degree in any discipline of Medical/Para-medical specialization from a reputable university.
• Healthcare/Hospital experience for 1-2 years, in departments such as Surgery, ICU or GP, is required.
• 1 – 2 years of work experience in the Insurance industry is preferable but not mandatory.
• Excellent oral and written communication skills.
• Must be computer literate.
• Excellent command of the English language, Arabic is a definite plus.
• Should be a team player with an aptitude for customer service. Must be service oriented.
• Highly decisive with outstanding logic and reasoning skills.
• Candidate must be tactful and discrete while dealing with Providers or Payers; must be able to handle confidential information.
• Ability to work under pressure and meet tight deadlines and varying work-schedules.
One of the leading “TPA” , Third Party Administrators in Medical Insurance ; a subsidiary of a fortune 20 Multi National Company , with extensive operation across GCC prospering over the last 18 years in facilitating our customers beyond their expectations in all services on par with global standards.
We are committed in ensuring to provide high quality , superior, innovative and cost-effective business solutions in the areas of healthcare and insurance services and embrace the good will of being one among the best leading TPA’s in this region serving over 50 insurance companies , in administering their multiple policies as well as catering to self-funded schemes with both international and local policies amidst our stake holders.
It is significant to share our accolades, that we serve more than 1.4 million members whilst administering over AED 4 billion worth of claims annually through a dedicated team of 700 + medical professionals in our talent pool from different parts of the world. We are partnered with a broad global network of over 4,000 health care providers in the region and always thrive to delight our customer through every service we provide remarkably.
We believe in attracting dynamic , focused , self-motivated , professionals with industry expertise to join hands with us to move forward in a journey, which promises growth and career establishment as per each one’s skills and potential.
Source: Job Posting - gulftalent.com
