medical claims officer
Al Buhaira National Insurance Company
Total des années d'expérience :6 years, 6 Mois
of outpatient consultations entered online.
•Verification and approval of lab tests and medications relevant to the details of consultation.
•Identification of chronic conditions of OP consultations and to ensure that the cost of chronic medicines is within the limit for the respective policies.
•Identify follow up consultations and repeated visits and direct the patient to proper facilities for definite management.
•Assess and approve the requests by GP doctor for specialist consultation.
•Send offline claim forms to network providers whenever required after verifying member details, verify and send the claim form for dispensation for medicines and enter the details online.
•Intimate to concerned authorities regarding infectious conditions diagnosed by network doctors.
•IP management - Assess the requests from network doctors for hospital treatment against the medical reports and lab investigations and then to intimate the concerned TPA/Insurance company.
•Interact with providers to clarify clinical details of members and to inform about exclusions and rejections.
•Manage helpline 24hours on rotation basis and maintain logbook about details of calls attended.
•Maintain records for print copies, medical reports, lab reports, and claim forms.
•Document and maintain the records of any rejections and cancellations.
•Address to the complaints received from members and clients and offer solutions to avoid recurrence of complaints.
2. Worked in
70 %
72.5 % JKBOSE KASHMIR,
74.2 % JKBOSE KASHMIR,