Insurance Coordinator
Al Wehda Medical Center
Total years of experience :9 years, 1 Months
• Processes insurance pre-approvals by sending through email, phone calls or insurance portals (GIG formerly AXA Insurance, QLM, Globemed, Nextcare, Al Koot).
• Provides customer service to insured patients by answering their queries and providing information.
• Responsible for checking and verifying patient's eligibility.
• Checks explanation of benefits for every approval to ensure the correct amount need to collect from the members for deductible, co-payments or co insurance.
• Takes note of all important details of each insurance contract (agreed discounts, claims submission deadlines and general exclusions)
• Checking the claims of other branches including the diagnosis code, tooth numbering, co-payment, attachments, etc.
• Processes claims submission, resubmission and reconciliation for all the branches through email and insurance portals (QLM, ALKOOT, GLOBEMED) and ensures early submission of each insurance within the agreed contract.
• Responsible for checking and uploading the scanned copy of claims into the QLM Unified File Portal for all the branches.
• Updates insurance reports with the latest payments from each insurance company and coordinates with the finance department in tallying each transaction.
• Identifies rejection reasons and notes action done.
• Prepares reports such as Monthly Income Statements and Payment details
• Reviews completeness of the claim.
• Scans all kinds of claims and making sure that all documents were saved in appropriate folders. Page 2