Medical Claims Processing Executive
AXA Insurance (Gulf)
Total years of experience :2 years, 7 Months
Key Responsibilities as a Medical Claims Specialist:
* Initiate contact with all parties involved in the claim on a timely basis to provide effective customer service.
* Verify policy coverage.
* Investigate all claims to determine if the injury/disease occurred in the course of employment, requiring payment of benefits.
* Determine the applicable laws, limits and primacy of coverage, and compensability and potential exposure of each claim’s jurisdiction.
* Evaluate all injuries for relationship to claim filed; review and study basic medical terminology. Maintain files and diaries of clear and concise notes of activities and action plans.
* Assign, monitor, and direct defense counsel in settlement negotiations and claim handling.
* Assessing and processing of medical insurance local and international claims- outpatients, inpatients.
* Work on local and International claims like UAE, India, Pakistan, UK, South Africa, Malaysia including HAA, Inter health, AXA assistance and Mednet.
* Worked mostly on all sort of claims Third Party claims/ Complex Claims.
* Adjudications of medical and hospital insurance claims.
* Contacting providers for claims submission and assisting them in submitting their bank details.
* Assisted the networking department in their day to day correspondence with the providers.
* Conducted workshop and seminars for corporate, Educational institutions and hospitals.
* Assisted the underwriting department in submitting quotations to the clients and general enquiries
* Overseeing seeing of overall correspondence of memorandums, proceedings, complaints and marketing activities.
* Negotiation for getting appropriate discount on high value claims.
* Responsible to release payment to all providers on time by applying appropriate exchange rates and bank charges.
* Completion of appropriate financial arrangements with providers including management of claim costs.