Claims Senior Reviewer

Job Purpose / Objective:

Responsible in monitoring all aspects of rejection & review invoices /patient medical files on daily basis, coordinating with insurance companies regarding issues related to claims, rejection and reconciliation

Key Responsibilities / Accountabilities:

• Monitor the rejection section and all aspects related to rejection and claims.
• Check & review invoices / patient medical files on daily basis, coordinating. With insurance companies regarding issues related to claims, rejection and reconciliation.
• Monitor the Claims Reviewer in reviewing claims & rejections.
• Prepare answer or justification for rejected claims.
• Prepares medical report as per requested by the insurance companies.
• Coordinate with physicians regarding re-explanation on rejected claims.
• Perform & complete of Reconciliation with Company & Hospital.
• Attend meeting for reconciliation along with the Business Service Manager.
• Provide information/orientation to all new doctors regarding Insurance Company and the all aspects of insurance policies.
• Analyse the rejections received from the insurance companies medically and administratively.
• Coordinate with the Claims Supervisor for any administrative rejections in order to improve the processing of the claims.
• Analyze the medical rejections and to coordinate with the concerned doctors / physicians for necessary orientation and guidance.
• Conduct quarterly presentation to the pharmacist.
• Provide insurance orientation to the doctors / physicians as per requested by the clinic.
• Participate in person-centered care initiatives undertaken by HMG.
• Enrich patient experience with compassion, respect and dignity.
• Perform other applicable task and duties assigned within the realm of his/her knowledge, skills and abilities.

Education/ Professional Qualification:

• BSC - MBBS

Experience:

• Medical insurance experience of 3-5 years

Professional Licensing / Certification / Training:

• N/A