senior medical Coordinator
al koot insurance and reinsurance company
Total des années d'expérience :14 years, 7 Mois
Area of specialization
General Medicine
Insurance Medicine
Medical Claims Management
Medical Audit/Review
Medical Underwriting
Utilization Management (Preauthorization/pre-certification/pre-approval)
1- Organize and supervise the activities and work of subordinates to ensure that all work within the Medical Claims section is carried out in an efficient manner which is consistent with operating procedures and policy.
2- Monitor and handle claims processing from different clients and policies according to the medical necessity, policy terms and conditions.
3- Coordinating day to day planning, operations and problem solving so that the team meets the required level of service and production.
4- Provide training to the new staffs on software, policies, contracts and work flow.
5- Correspondence with partner for claims processing, payments and improvement of the Medical Insurance schemes available.
6- Coordinate with IT Department for all IT related issues connected with Medical and dental claims systems.
7- Reviewing, suggesting and implementing the policies and procedures to suit the demand of the business in terms of quality and accuracy in claims processing.
8- Assist management in resolving outstanding and disputed reimbursement claims with the provider’s doctors/insurance professionals in order to ensure timely resolutions to claims.
9- Build and maintain ongoing relationships with clients/providers including scheduling and attending meetings to understand the nature of businesses.
10- Carry out presentations to clients/providers to explain the benefits, terms & conditions of the medical insurance policies.
11- Works closely with the team members to resolve customer’s problems, handling calls and issues of the customers in order to provide the appropriate assistance and guidance in resolving issues related to the business.
12- Assist members for Medical treatment arrangements locally and outside Qatar to ensure they receive the appropriate health care needed.
13- Undertake claims awareness initiatives such as programmes, presentations and seminars to ensure clients are aware and understand Medical Insurance matters regarding Al-Koot/Provider’s claim handling policies and procedures.
14- Conduct the essential auditing activities with regards to clinics in order to identify and blacklist those with fraudulent or abusive activities.
15- Liaise with clients on regular basis regarding medical related issues of patients such as insurance cards.