Medical Claims Officer
Oman Insurance Company
Total years of experience :10 years, 11 Months
PAR UNIT
Health Department
•Verifies the enrollment status of claimants.
•Processes pre-authorization approvals (for Inpatient & Outpatient, Optical, Dental and Pharmacy) received from different providers through calls, fax and e-mails, for both Direct Billing and Reimbursement.
•Coordinates with medical providers for verification of documents and wherever additional information is required to assess medical requests properly before giving out any approvals for any procedure or prescription.
•Facilitates direct billing arrangements with international providers.
•Educates members, providers and intermediaries the medical claims processes and approval request protocols.
•Investigates, assists and answers queries / complains of health providers, members and brokers.
Verifies the enrollment status of claimant, at the same time, inspecting all claim documents.
•Implements fixed policies prearranged by the insurance companies catering to members individually and by group (up to 100, 000 lives)
•Provides initial assessment of claims using policy wordings and communicate decisions to both customers and clients.
•Coordinates with medical providers for verification of documents and wherever additional information is required to assess medical requests properly before giving out any approvals for any procedure or prescription.
•Gives pre-authorization approvals to hospital providers who need any medical services, such as: IN-PATIENT / OUT-PATIENT / OPTICAL / DENTAL / PHARMACY, for eligible members of a specific insurance company.
•Confers and relays with members any updates / revisions made by their respective insurance companies.
•Investigates, assists and answers queries / complains of health providers, members, brokers and insurance companies.
•Refers unresolved customer grievances to designated departments for further investigation.
•Keeps records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
•Works with a team to ensure proper procedures on handling clients in a timely manner.
-Verifies the enrollment status of claimant, at the same time, inspecting all claim documents.
-Implements fixed policies prearranged by the insurance companies catering to members individually and by group (up to 100, 000 lives)
-Provides initial assessment of claims using policy wordings and communicate decisions to both customers and clients.
-Coordinates with medical providers for verification of documents and wherever additional information is required to assess medical requests properly before giving out any approvals for any procedure or prescription.
-Gives pre-authorization approvals to hospital providers who need any medical services, such as: IN-PATIENT / OUT-PATIENT / OPTICAL / DENTAL / PHARMACY, for eligible members of a specific insurance company.
-Confers and relays with members any updates / revisions made by their respective insurance companies.
-Investigates, assists and answers queries / complains of health providers, members, brokers and insurance companies.
-Refers unresolved customer grievances to designated departments for further investigation.
-Keeps records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
-Works with a team to ensure proper procedures on handling clients in a timely manner.
Blood Bank Services)
•assessing, observing and reporting on the condition of patients
•screening of prospective blood donors
•demonstrating donor’s care, proper technique in venipuncture / phlebotomy and blood collection
•responding quickly to emergencies
•preparing patients for procedures
•recording of vital signs and keeping accurate records of these observations
•supporting, advising and educating patients and close relatives;
•engaging in teamwork with the rest of the healthcare team
•writing reports and updating records