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Job Description
- Reviewing, auditing, and settling payments of monthly reimbursements, OSD, and provider claims within the assigned SLA.
- Aiding the issuance team in policy renewal, consumption, and loss ratio processing.
- Claims analysis and following up scheme performance.
- Handling approvals whether for chronic medication or surgeries to meet the client’s needs concerning each policy.
- Keen on being in contact with the key person of each policy to provide satisfactory service and solve any problems.
- Receiving cheques and ensuring their delivery at the appropriate time for the client.
- Able to communicate daily with different TPAs and Client requests including the following reimbursement, solving complaints, approving, and following debit notes payments, studying exceptions.
- Able to generate loss ratio, Outstanding, IBNR, and Consumption reports from the different online systems.
- Preparing monthly statistics.
- Archiving claims boxes.
- Prescribing and dispensing medication, aid in getting approval, measuring blood pressure and collecting reimbursements
Job Requirements
- 2-4 years of experience.
- University degree “pharmacy”.
- Studies in insurance are defiantly a plus.
- Interpersonal and negotiations skills
