Medical Claims assessor

Job description

Summary

The Medical Claims – Assessor will provide quality service to clients by promptly and effectively assessing and processing claims and approval according to operations set standards.

 

Main Tasks

 

•Manages routine daily claims administration work.

•Coordinates work flow & meet deadlines.

•Evaluates claims with regards to eligibility.

•International Preauthorization.

•Attends calls and e-mails from insurance companies, clients, and providers.

•Makes suggestions to improve service.

•Increases efficiency, minimizes errors, and administration time.

•Coordinates with different departments within the company.

•Reports errors when detected.

 

Behavioral Requirements

•Strong verbal and written communication skills.  Must have the ability to communicate sensitively and effectively with claims department and other departments having regards for the strict need for confidentiality.

•Show flexibility, excellent interpersonal skills.

•Team Player.

•Knowledge of overall insurance industry practices is a plus; the ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.

•Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others.

•To be capable of responding diplomatically to pressures and problems showing a calm approach to working towards deadlines and always able to show an innovative and creative approach to work.

•Ability to work well with all levels of internal management and staff, as well as outside clients and users.

•Flexible and ability to work shift .

 

Behavioral Competency

Customer & Market Excellence:

•Strive for excellence at every touch point with the customer

•Foster state-of-art  technical/operational knowledge and strive for continuous simplification

•Be the benchmark

Collaborative Leadership:

•Empower the team and provide purpose and direction

•Develop people, provide  feedback and care to employee wellbeing

•Collaborate and exchange best practice.

Entrepreneurship:

•Act on opportunities, anticipate trends, take risk, and promote a culture that allows for honest failure

•Take ownership and responsibility

•Embrace innovation and a culture that allows to make decisions without fear of retribution.

Trust:

•Act with integrity, honor commitments, tell the truth

•Foster diversity and inclusiveness

Act transparently and promote corporate social responsibility.

Minimum Requirements

•Bachelor’s degree (Nursing): with at least 2 years of clinical experience.

•3+ years claims processing experience in an Insurance / TPA environment, A Must to have coding Expierence.

•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.