Summary: This role involves processing preauthorizations, interacting with providers, ensuring accuracy and compliance, managing claims, and resolving customer queries. Highlights: 1. Ensuring error-free processing and compliance with regulatory procedures 2. Interacting with providers to complete claim documentation 3. Managing claims and meeting internal KPIs * Ensuring error free processing of preauthorization within agreed TAT (Turnaround time) by way of following the process. * Inform providers as needed and file completed precertification requests as per procedures * Interacting with providers to complete the claim documentation etc. As and when required. * Ensure the accuracy of all the authorization approval as per the process. * Any authorization not as per the limit or as per the process to be escalated to the team manager on priority. * Ensuring process compliance is met as per regulatory procedures. * Maintaining Daily excel maintenance for Pre\-auth cases received and processed. * Solving customer queries wherever medical opinions are required and need to be address by the medical practitioner. * Receive and process complaint, request received from customer care * Detect fraud and raise the suspected cases to the concerned team * Follow all relevant departmental policies, processes, standard operating procedures and instructions so that work is carried out in a controlled and consistent manner. * To manage claims and ensure that internal KPI’s are met as per the procedure manual. Job Type: Full\-time Pay: QAR9,250\.00 per month Application Question(s): * Are you comfortable working in Insurance Industry? Education: * Bachelor's (Required) Work Location: In person
Fatima Al-Kuwari
Indeed · HR
Fatima Al-Kuwari
Indeed · HR
