Job Summary
Case management, handling all outpatient, inpatient, specialized services preauthorization, and Communicating with providers, clients and brokers on a timely basis
Job Description
Manage 24 hour call centre
Prompt response to emails, admissions requests.
Critical analyzation of all medical requests from service providers.
Efficient & accurate submission of approvals in line with the medical policy .
Obtaining medical information from providers with written correspondence if necessary.
Capacity to continually apply negotiation skills with the service providers
Interacting with clients, Intermediaries and services providers as required to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy.
Accurate checking and confirming membership validity, benefits and sending member statement upon enquiry.
Accurate guidance on provider network enquiries from brokers, providers, members etc.
Vetting and confirming validity of the service given by the service provider in relation to the member benefit covered, treatment given, adherence to provider panel rules and cost of treatment
Obtaining additional required information on invoice/claims from providers or clients.
Education
Further Education and Training Certificate (FETC): Business, Commerce and Management Studies (Required)
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