Running our operations in a responsible, sustainable way.
Job purpose: To assess and evaluate the preapproval requests received by the providers in terms of medical eligibility and policy terms and meeting the client expectations appropriately and providing a World Class Customer Service experience throughout the process.
Key Responsibilities: - Adjudicating and Processing insurance pre-approvals in a timely and accurate manner following Company policy terms and conditions, process Guidelines. Process pre-approvals within the agreed TAT per line of business.
- Providing preapproval for medical claims based on medical eligibility and policy terms.
- Contribution in cost containment through GIG Guidelines and proper medical adjudication.
- Contribution in Fraud Waste and Abuse management in the pre-approval function.
- Assist team leaders in Queue management, Customer care email management as required on adhoc basis.