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Job Description
- Examine claims records and forms to determine whether the patient has medical insurance.
- Review provisions of certificate or policy to determine the patient’s included medical coverage losses.
- Negotiate claim settlements and make recommendations for settlements.
- Complete logs, reports, forms and records to properly document medical claims.
- Reject or accept documentation, determine benefit due, and start the denial or payment process to resolve medical claims.
- Adhere to all company policies, procedures and guidelines in addition to insurance regulations at Hospital.
- Examine medical treatment records, reports and medical bills to gauge overall extent of liability.
- Interview and communicate with claimants, physicians and other necessary individuals to decide claim denial, settlement or review.
- Ensure all claims information remains confidential.
- Resolving customer complaints by investigating issues and recommending solutions
- Preparing reports on claims status and other details about policyholders’ accounts, including payment histories and outstanding balances.
Job Requirements
- BSc in Medicine. (Only Physicians)
- 3-5 years experience in Medical Insurance & Claims Handling at private hospitals.
- Private Hospital background is a must + medical insurance companies.
- Strong Communication Skills.
- Leadership Skills.
