Medical Claims Processing Assistant
AXA Insurance
مجموع سنوات الخبرة :15 years, 4 أشهر
• To receive Medical Claims from the providers (hospitals, Medical centre, Pharmacies and other health care units) and segregation them in accordance to Reimbursement claims and Direct Billing claims.
• Validate and Register medical claims information on the AXA claims processing system (Ciris)
• Reviewing Claims thoroughly and ensure that there is no missing or incomplete information
• Ensuring that all information contained in the claim is accurate and that no discrepancies exist.
• Scanning and outsourcing the claims to the Claims processing team
• Co-ordinate and Assist with Claims offshore and onshore Processing team in order to complete the smooth flow of processing.
• Liaise with Medical network team during any form of provider discrepancies
• Communicate with individual members in case of queries regarding their claims submission.
• Remit the payment to providers or Individual members upon processing their claims.
• Ensuring all the claims are duly filed and recorded for any future references.
• Managing and handling the team consisting of 14 members.
• Responsible to generate MIS reports and ad-hoc reports on a daily basis and report the same to Internal Management and Onshore Clients.
• Part of a resource management team of the Project, thereby forecasting the resource requirement and recruit suitable FTEs without deviating from the Profit and Loss culture, coordinating with the Human Resources department and Management.
• Daily & periodical interaction with the Onshore Client over the Conference call and Webex sessions if required.
• Manage the day to day operations and meet the deliverables of the process, to ensure the Customer Satisfaction is always exceeded by achieving the SLA’s. Also act proactively analyzing the crisis situation and prepare a mitigation plan independently discussing with the Client and the Management.
• Set Key Performance indicators for the individuals and ensure the Company’s objective is met, thereby always exceeding Customers expectations and initiate new business prospects.
• A Subject Matter Expert in Premiums End to End Processing, a complex line of business involving huge Financial Transactions majorly across the UK and US geographies
• Appraise the individuals on the yearly performance and provide feedback to management based on their quality and additional responsibilities.
• Quarterly performance appraisal for team members and counseling them for better performance and personal development.
• Conducting weekly Team Review meeting to keep the team members updated on their productivity and quality status.
• Counseling team members from time to time to keep them motivated to work. Conducting a general chat session with team members to know their state of mind.
• Taking part in Project Management Review meetings to discuss process specific issues and getting solutions by Brainstorming.
• Monitor deadlines and ensure timely delivery of projects. Negotiate deadlines when necessary (TAT).