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Job Description
- Reviews and audits all reimbursement claims ,ensuring that the required documents are successfully submitted
- Reviews and evaluates policy coverage verses the submitted claims, ensuring that it is correctly settled on the system
- Processing the claims on the system
- Reporting & following up the system problems whenever appears
- Following up with the gateway admins to check services duplication
- Following up with the assigned account manager if there is any concern & exception shall be taken upon claims processing
- Following up with mapping & coding team to add new services on the different bench marks whenever is needed
- Following up with PBM team to add new meds or to change the prices according to latest market prices
- Following up the emails that are related to each assigned working areas
- Reprocessing of claims according to documents completion or Risk carrier exceptions
Job Requirements
- BS degree in Medicine from a reputable university.
- One year at least of experience as a Physician or a Medical claims processing.
- One year of experience in TPA industry
- Good to very good command of English language.
- Strong analytical skills, organizational skills with the ability to handle multiple assignments.
