Senior Medical Claims Officer - Physicians

Job description

Description:

Senior Medical Claims officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards.

Senior Medical Claims officer is also responsible for team success by agreeing, implementing and monitoring individual and team objectives and targets ensuring company policies and procedures are adhered to.

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.