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Senior Claims Adjuster

Al Ahly Medical Company
Giza, Giza
Posted 4 years ago
95Applicants for1 open position
  • 63Viewed
  • 1In Consideration
  • 0Not Selected
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Job Details

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Job Description

  • Be aware of each policy, table of benefit and exception for each client to ensure the proper processing of the claims.
  • Ensure the competence of the documents of each claim according to claims processing procedures and ensuring that all the needed information is valid.
  • Revise the medical procedures with the diagnoses to check whether justified and correlated medically.
  • Ensure that the medical provider sticks to the operation procedures and card instructions for example: approvals are obtained if needed.
  • Ensure the adherence of the claimed amounts to the medical procedures provided to the beneficiary who is already requested from the physician.
  • Review the price of the medical procedures and compare it with the stated price lists to ensure that they are financially aligned.
  • Preparing POs for issuance
  • Reporting daily and weekly production to the "Unit's Supervisor "
  • Conduct on job training to the new staff to transfer the knowledge to them to be aware with the department’s procedures and work nature
  • Performs other tasks as assigned (by line Manager) within the realm of his/her position, qualifications and capabilities.

Job Requirements

  • BSc in Pharmacy
  • Certified courses in healthcare management
  • 2 - 4 years of experience
  • Ms office Suite
  • Good English

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JobsMedical/HealthcareSenior Claims Adjuster