Job Details
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Job Description
- Reporting Fraud suspicious cases to internal department for taking their corrective actions
- Check medical diagnosis with medical service required for approval request received from admin
- Check if need any further evidence
- Save the approval on shared sharing for the admin to be send to the client
- Check beneficiary’s medical coverage limit applicable for the required service
- Check beneficiary agreement plan
- Update system and ensure approval cases granted approval number
- Ask for medical report details from the hospitals about the impatient to reduce the fraud rate
- Doing manual approval for clients that are not updated yet on the system
- Answer calls for any medical justifications required from beneficiaries.
- providers or clients regarding medical usage and agreement benefits
- Refer back to call center team to Confirm usage before deletion or modification of approvals.
- contact the doctors for any medical inquiries
- following up inpatient cases
- raise flag for unjustified cases to be reviewed by the in house doctors
- On call emergency cases
- Handle complaints and rejected cases when required
Job Requirements
- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Talking to others to convey information effectively
- Service Orientation: Actively looking for ways to help people.
- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems
- Time management.
- Preferred to have experience as a doctor
- Preferred to have experience in insurance companies
- Bachelor’s Degree in medicine
