Responsible for providing our customers with a peerless service experience and claims journey by assessing and processing claims accurately and consistently.
With a detailed understanding of the claims lifecycle from receipt to closure, the postholder will provide best-in-class customer service through high-
quality correspondence and fulfilment of service promises.
Deliver timely and accurate claims administration services : claims adjudication, data entry, production of claims correspondence such as claims settlements, declinations, information requests, etc.
Establish and maintain excellent knowledge of Now Health Internationalâ€™s products, claims handling procedures and systems (OH+).
Assess claims as per defined work flows and delegated authority limits.
Follow referral procedures on claims which are outside delegated authorities while dealing with medical review, case management, recovery claims, possible abuse & fraud and complete claim file.
Able to makes sound judgment based on available claims information provided. Gives reason for decision made and ability to justify the same.
Maintain records of large losses, ex gratia payments, major denials and support other routine and ad hoc reporting requirements.
Adhere to all the KPIs listed below :
Claim settlement to client / customer within 5 days
Process claim invoices within 3 days
Request medical information within 3 days
Claims settlement to provider within 15 days
Process claims provider invoices within 10 days
Request additional information within 10 days
Adhere to and improve best practice processes across the claims operations, including the delivery of all the agreed service standards.
Prepare regular claims report to meet the partnersâ€™ requirement.