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JOB PURPOSE
The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per terms of benefits. He/She should provide accurate and relevant medical coverage details and maintain pre-approvals and claims processing as per the defined terms and policies of the organization.
RESPONSIBILITIES AND DUTIES
Processes claims from members and providers.
Assists queries from providers and payers via phone calls or e-mails.
Maintains files for authorizations and other reports.
Assesses and processes claims in line with the policy coverage and medical necessity.
Be fully versed with medical insurance policies for various groups / beneficiaries.
May assist in training colleagues and asked to share know...