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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