medical insurance processor
Al Ahli Hospital
مجموع سنوات الخبرة :19 years, 4 أشهر
• Validate the insurance coverage and eligibility of the patient.
• To make sure the claim form is completely filled up by the doctor.
• Verify and attach the necessary documents like lab result, rad result, prescription and approval if needed for submission of paper claims.
• Enter claims data into the system for electronic submission.
• Follow adjudication policies and procedure to make sure the proper payment of claims.
• Performed audit of all claims to ensure quality processing
- Sending preauthorization request for medicine, laboratory investigations and radiology test to insurance companies.
- Called insurance provider for preauthorization of medication (chronic medication that exceeded the limit, dental medication and psychiatric medication).
- Updates the system with the outcome of preauthorization request (approved, partially approved or with insurance query).
- Communicates with assigned clinical staff departments to obtain additional information as required by insurance provider.
- Prepared summary report and statement of account for all invoices to be submitted to different insurance companies.
- Prepared the packing and delivery of insurance claims through Fedex.
- Safe keeping of all receiving copy of statement of account.
- Updated Finance department on all submission of medical insurance claims on weekly basis.
Account Officer - Non Motor Insurance
February 2007 to October 2007
• Handled and monitored insurance requirement of existing and potential client of various branches of China Bank and Consumer Banking Group Housing Loan Division - Head Office.
• Conducted client presentation, inspection and prepares quotation for potential and existing clientele. Audits and checks details of issued policy from insurance companies.
• Facilitated renewal of policy for existing accounts for individual and corporate clients.
• Prepared production report and monitor collection of accounts receivable on monthly basis.
• Scheduled and monitored all the insurance policy for delivery
• Received request from telemarketers for issuance of insurance policy and coordinates the same to insurance companies.
• Audited and double checked all requested policy details and policy clauses.
• Scheduled and monitored all policy for delivery.
• Coordinated with Consumer Banking Group (Car Loan Division) on bank mortgaged accounts to verify that all requested policy for new business and expirees were furnished.
• Monitored and handled car fleet insurance of China bank’s services and armored car.
• Assisted in monitoring and collection of accounts receivable, receiving motorcar quotation request, help out on motorcar product presentation to potential client and claims processing.
• Assigned in different event sponsored by car manufacturer and China bank to present motor insurance products and other services to potential client.
U.S. EMBASSY MANILA SCHOLAR FROM 2000 TO 2004, with practicum in Philippine Savings Bank for 400 hours, and with a GPA of 85 percent.