Medical Liaison Agent
Metlife
مجموع سنوات الخبرة :16 years, 2 أشهر
• Supports the approval team in handling call inquiries and update pre-approvals in the system accordingly. • Records calls and assists enqueries regarding Medical approvals from providers, Insured members, agents and brokers • Provides support on Maternity, Optical and dental approvals. • Maintain records of received calls from the Pharmacy management in Abu Dhabi and Dubai • Answers emails pertaining to any related PBM requests/issues from the network and non-network providers. • Maintain records of verbal authorizations • Upload all Fax/Email authorizations on the claims online system. • Provide general support to insured members on the status of their pre-authorization. • Assist in filing all guarantee letters and maintain records of the same. • Assist with Second Medical Opinion cases and maintain records. • Call Insured Members and providers to update and follow up on second opinion cases • Maintain record of telemedicine cases.
• Reviews and validates group medical claims, assures the accurate input of name, date, diagnosis and approval of claims on the claim system.
• Process out-patient claims according to the policy terms and conditions.
• Pursues providers to arrange their bills in a way facilitate our process to the new project of E-claims
• Obtain information from healthcare providers to verify the accuracy and completeness of information on claims forms if needed.
• Registers and stamps the number on claims documents.
• Receives incoming calls, attends to patients’ queries, book appointments for the patients.
• Prepares administrative and functional reports to the manager.
• Registers patients in Electronic Medical Record.
• Provides explanation/guidance on insurance coverage limited to the coverage of the insured patient.
• Verifies insurance coverage and benefits of the patients from insurance companies.
• Prepares the filled insurances forms, invoices, official receipts, clinical and testing pre-requisites, certification requirements for outgoing patients.
• Receives the payment from the patients.
• Oversees all aspect of general office coordination.
• Records and updates all the patient information to Dentimax program and keeps the patient files accordingly.
• Prepares the monthly summary of income and expenses of the clinic.
• Supervises the ordering of the clinic consumables and the monthly payables accordingly.
• Prepares responses to emails and correspondences as directed by the supervisor.
• Arranges the director’s schedule.
• Submits the monthly financial reports to the manager.
• Uploads the monthly data of patients to HIRAS on a monthly basis.
• Takes charge in the safekeeping of manual and electronic records of the patients.
• Composes correspondence on a variety of subjects
• Records accurately all business transacted at each meeting of the association and presents the minutes for approval at the next meeting of the same body.
• Performs the supervisory function, which includes interviewing employee, screens and interviews applicants, providing feedback.
• Greet visitors, answers telephone calls, queries and determine whether they should be given access to specific individuals.
• Make travel arrangements for executives.
• Manage and maintain executives' schedules.
• Open, sort, and distribute incoming correspondence, including faxes and email.
• Prepare invoices, sales reports, memos, letters, cheques and other documents, using word processing, spreadsheet, database.
• Prepare responses to emails and correspondence containing routine inquiries.
• Administrative duties include filing, issue PO etc, AR/AP, follow up with customers to make payments.
• Sales coordination with outdoor and indoor salesmen.
• Supervise delivery staff and schedule deliveries.
• Receive and keep track of inventory.
• Procurement of office supplies and pantry supplies.