Description
The Medical Coverage Specialist serves providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests, and maintaining databases.
Responsibilities and Duties:
- Issue online and verbal authorizations based on member coverage and medical justification
- Assist queries from providers and payers via phone calls or emails
- Maintain files for authorizations and other reports
- Assess and process claims in line with policy coverage and medical necessity
- Be fully versed with medical insurance policies for various groups and beneficiaries
- Assist in training colleagues and sharing knowledge
- Accurately assess eligibility within UAE guidelines and policy boundaries
- Monitor and maintain the claims processing and adjudicating cycle in NHS operational software systems
- Establish strategies and implement effective parameters for solving queries
- Take a lead role in ensuring assigned tasks are completed within allocated time frames
- Ensure proper communication and implementation of new formats, training, and processing rules
- Enter and process claims in NHS operational software systems
- Take initiatives to maximize team efficiency
- Maintain qualitative and quantitative claims measures
- Ensure adherence to predefined TATs for claims and pre-approvals
Knowledge, Skills, and Experience:
- University degree in any discipline of Medical/Para-medical specialization from a reputable university
- 1-2 years of healthcare/hospital experience in departments such as Surgery, ICU, or GP
- 1-2 years of work experience in the insurance industry (preferable but not mandatory)
- Excellent oral and written communication skills
- Computer literacy
- Excellent command of English; Arabic is a definite plus
- Team player with an aptitude for customer service
- Highly decisive with outstanding logic and reasoning skills
- Tactful and discreet when dealing with providers or payers; able to handle confidential information
- Ability to work under pressure and meet tight deadlines and varying work schedules
For more fresh new jobs, check out yubhub.co.