Medical Claims Processor
Allianz Care
Total des années d'expérience :4 years, 9 Mois
Receive claims notifications and handle the entire process of claim verification up to decision-making per company procedures and authority matrix.
• Communicate with internal and external providers to collect all required claims documentation and verification.
• Present reports and administrative tasks related to claims management.
• Respond to customer inquiries to ensure effectiveness and achieve customer satisfaction.
• Manage routine daily claims administration work and increase efficiency, minimizing errors and administrative time.
• Contribute to providing products for the team and departments to ensure a high level of service following the company's policies.
• Use AWC's customer database accurately and effectively to ensure reporting is generated to give a true reflection of the department's workload.
• Assess claim settlement within designated authority limit, and Communicate claims decisions.
• Analyze and investigate complicated insurance claims to help prevent fraud.
Recognized and refuted potential fraudulent information and proactively sought to clarify and resolve issues using the best method of communication and initiative.
• Examined claims records and forms to determine whether the patient had medical insurance.
• Negotiated claims and made recommendations for legal action when settlements were deemed non-negotiable.
• Interviewed and communicated with claimants, physicians, and other necessary individuals to decide claim denial, settlement, or review.
• Reviewed and audited all reimbursement claims and ensured that the required documents are submitted successfully.
• Handled approvals for either chronic medications or surgeries to meet client needs concerning each policy.
• Participated in departmental medical training to expand knowledge of medical terminology and procedures and to develop comprehensive claims processing skills.
• Contributed clinical expertise to patient care and guided junior physicians.
• Ensured the highest standards in patient care were maintained.
• Contacted medical Insurance companies for approved dispensing.
• Recommended preventative care measures to reduce the risk of illness or injury.
• Educated patients about their diagnosis and treatment options and answered questions about their condition.
• Planned, implemented, and maintained procedures for mixing, packaging, and labeling pharmaceuticals.
• Maintained stock of pharmaceutical supplies, medical supplies, and drugs, maintaining stock and storing, and handling them properly.
• Listened to patients’ reports of symptoms and provided suggestions for over-the-counter medications.
• Allocated, measured, prepared, and distributed proper medications to the patients that needed them.
• Advised regarding drug interactions, side effects, dosage, and proper storage of medications.
Formed and dispensed medicines as directed by physicians.
• Monitored clients' drug treatments, advised on interventions and informed clients of potential side effects.
• Instructed clients on how and when to take prescribed medications.
• Provided vaccinations and other medical services such as measuring blood pressure, temperature measurements, and checking blood sugar levels.
• Reviewed prescriptions to assure accuracy, ascertain the needed ingredients, and evaluate their suitability.