Claims Officer
Allianz Partners
Total years of experience :4 years, 4 Months
- Responsible for performing technical and medical audit on uploaded claims and ensure an appropriate application of policy and tariff agreements.
- Assure a quality control through the reports. The analyst checks the policy, due dates, pricing rules and correct the discrepancies.
- Performs a full range of professional medical claims analyst assignments in a full functioning capacity. Considerable independent judgment is used to make decisions in carrying out assignments that have significant impact on services or programs.
- Compare the insurance medical bills of participants, taking into account the diagnosis, the treatment and their amount in accordance with medical insurance policies
- Handling Direct Billing and Reimbursement Claims.
- Act as an advisory body for all medical departments.
- Responsible for performing technical and medical audit on uploaded claims and ensure an appropriate application of policy and tariff agreements.
- Assure a quality control through the reports. The analyst checks the policy, due dates, pricing rules and correct the discrepancies.
- Performs a full range of professional medical claims analyst assignments in a full functioning capacity. Considerable independent judgment is used to make decisions in carrying out assignments that have significant impact on services or programs.
- Compare the insurance medical bills of participants, taking into account the diagnosis, the treatment and their amount in accordance with medical insurance policies
- Act as an advisory body for all medical departments.
- Responsible for performing technical and medical audit on uploaded claims and ensure an appropriate application of policy and tariff agreements.
- Assure a quality control through the reports. The analyst checks the policy, due dates, pricing rules and correct the discrepancies.
- Performs a full range of professional medical claims analyst assignments in a full functioning capacity. Considerable independent judgment is used to make decisions in carrying out assignments that have significant impact on services or programs.
- Processing Prior Authorization requests referred by the call center via I*care.
- Compare the insurance medical bills of participants, taking into account the diagnosis, the treatment and their amount in accordance with medical insurance policies
- Act as an advisory body for all medical departments.
- As a resident physician provides a general primary obstetric and gynecologic care to in and out patients.
- Takes patient’s history, examines patient, diagnose and render the appropriate plan of care for each patient.
- Performs general obstetric and gynecologic procedures both diagnostic and therapeutic.
- Refer patients to Consultant and other
As a Resident Physician we interview and take history of patients inside the hospital. We take their vital signs and perform a physical examination. When assigned in the laboratory we screened blood donors, perform phlebotomy and assist the pathologist in handling specimen.
When designated at the ward we do all patient care activities and monitor patients status. We analyze and interpret laboratory results and monitor patients progress.
- Makes a medical history and clarifies information with the patient.
- Examines patient by conducting physical examinations and recording of results.
- Takes or orders specimen smears, blood tests, x-rays, and other tests to supplement the examination and to assist in evaluating patient’s signs and symptoms and problems.
- Makes and confirms diagnosis of patient’s condition.
- Confers with the attending physician to discuss findings and to plan a course of treatment consistent with medical history and other patient’s requirements.
- Discusses findings of examinations and tests with patient and caregivers and recommends and prescribes treatment and approaches to improve health and well-being.
- Administers treatments and prescribes medications to treat illnesses and health problems of patients.
- Conducts follow up examination and test to determine benefits of treatment programs and patient condition and revises treatment in response to findings.
- Records patient information, diagnosis, prescriptions, treatments and patient response to treatment and medication.
- Discusses patient condition, treatment and prognosis with family member and caregivers and answer their queries.
I was assigned to work in the various section of the laboratory namely: hematology, blood bank, clinical microscopy, clinical chemistry, microbiology and serology.
