Team Leader
Neuron LLC
Total years of experience :6 years, 4 Months
Look after the team’s daily task: policy set-up, renewals, updates and modifications, ensuring that all endorsements are attended to.
• Continuously updating the system, under the monitoring of the IT Dept., contributing to the steady rise in automation on both claims and authorization level.
• Provide support for PBM (Pharmacy Benefit Management), claims processing, pre-authorization & customer service issues.
• Perform quality checks on processed policies.
• Communicate with clients on any clarification of benefits and their coverage, ensuring that this is compliant according to the regulator’s mandate.
• Conduct regular audit of policies, client benefit and exclusions, and update as necessary.
• Proficient in Neuron systems and able to assimilate and translate relevant information on products and policies.
• Maintain a strong and collaborative relationship with Provider Network, Client Relations, and Operations teams to ensure a similar understanding regarding the policy administration of a specific group or client.
• Audit the print list for Cigna members and sign-off the cards that have been printed before dispatch.
• Conduct training for new joiners as well as interdepartmental trainings on the updates and added system functionalities.
• Facilitate the projects to be accomplished by the team on a quarterly basis.
• Conduct interviews to candidates when there is a vacancy.
• Rules check in the Medical Level with CEED (Coding Edit Engine of Dubai) and FDB (First Data Bank).
• Monitor performance of PBM with the required TAT in Pre-authorization and Claims Processing.
•Work closely with IT Dept. regarding the updates on the TOB Screen, Provider Portal, Claims Screen, Authorization Screen, PBM & E-Authorization Portal.
• Secure all necessary data to ensure appropriate implementation based on applied logic of E-Rx and PBM.
•Develop client specific implementation plans and manage implementation processes (rules to apply for specific policies, subgroups and categories.).