DubaiAED9,500 - AED10,000 a monthJob Responsibilities : Assess day-care and in-patient cases as per medical justification and policy coverage.
Escalate and confirm grey-area cases. Confirming of exclusions of borderline cases OP / IP.Assists CC officers and supervisors in claims adjudication cases as needed.
Sending request of confirmation and notification to corresponding payers as needed.Responding to payer's queries in relation to day-care and In-patient cases.
Responding to the payers request for advice on coverage of cases.Monitor Claims cost as per internal guidelines.Rejecting medically unjustified and policy wise excluded day-care and in-patient cases to be signed by Chief Medical Officer.
Conformity of assessment for the prescribed tests / medications / investigations / clinical proceduresIssuing day-care and In-patient cases Reimbursement Approval in line with medical and policy coverage.
Contacting provider for queries and clarifications.Doing clinical discussion directly with the network's doctor as needed.
Seeking verbal clinical opinion from Network's doctor as needed.Candidate's Qualification : Medical Doctor (MBBS degree / MD degree)2 - 6 years’ experience in the healthcare industry / hospitals is preferable but not mandatoryBasic Industry knowledge (healthcare / insurance)Should be a team-player with an aptitude for customer serviceMust be service orientedHighly decisive with outstanding logic and reasoning skillsExcellent oral and written communication skillsMust be computer literateExcellent command of the English language, Arabic is a plusCandidate must be tactful and discrete when dealing with clients and must be able to handle confidential informationAbility to work under pressure and meet tight deadlines and varying work-schedulesJob Type : Full-timeSalary : AED9,500.
00 to AED10,000.00 / monthExperience : hospital : 1 year (Preferred)Insurance : 1 year (Preferred)healthcare : 1 year (Preferred)Education : Bachelor's (Preferred)Location : Dubai (Preferred)Language : English (Preferred)