Job description
Job purpose
Maintaining constant contact with hospitals to ensure continuous well-being of all the stakeholders and handling of medical claims with efficiency and accuracy.
Key responsibilities
Pre-authorize scheduled and non-scheduled admissions within the set guidelines
Liaise with the hospitals and doctors for prompt submission of the admission summary form
Monitor procedures being carried out on patients and see to the general well being of the patient
Assess and authenticate inpatient and outpatient medical claim documents
Revise reserves after discharge of a member
Ensure smooth discharge process and co-ordinate any necessary post-hospitalization care
Visit health care Institutions in the assigned region to confirm admissions.
Prompt collection of claims paid out of policy liability
Process reimbursements within the stipulated time
Assist in carrying out verification and medical audit of claims invoices before settlement
Handling of the 24 hour helpline.
Key Performance Measures
% Claims turnaround time
% customer complaints resolved within SLA
# of customers engaged in awareness training
Customer satisfaction index
Net promoter score (Customers)
Knowledge, Experience And Qualifications Required
Diploma in Nursing
Basic understanding of insurance concepts
3.1-2 years’ experience in case and claims management
Professional qualification in ACII, IIK is an added advantage.
Competencies
Knowledge of insurance concepts
Knowledge of case management processes and procedures
Knowledge of insurance regulatory requirements
Core competencies
Good Communication skills
Building Relationships
Focuses on the Customers
Develops Self
Solves Problems
