Claims Processing Agent

Your tasks

• Evaluates medical claims from the technical and medical perspectives as per policy terms and conditions.
• Guides claims officers in handling difficult medical cases and optimizes the quality and quantity of output.
• Checks if a particular treatment plan is necessary for the patient.
• Analyzes provider abuse, pattern, and trend.
• Conducts good analysis of fraud, waste, and abuse.
• Refers cases for a second opinion when there is doubt in the treatment plan.
• Provides clients with an understanding of any declined medical claims.
• Maintains daily productivity targets and service levels.
• Manages routine daily claims administration work.
• Coordinates workflow and meets deadlines.

Requirements

• Bachelor of Medicine (MBBS), BDS, Pharmacy, or Nurse.
• 2+ years of medical practical experience (reputable insurance provider, broker, or TPA experience is a plus).
• Physically fit to carry out duties.
• Legally permitted to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.