Medical Claims Specialist
1 week ago
**Responsibilities**:
- Conduct a robust and comprehensive auditing function for all health claims assessed by external claims management companies.
- Monitor and analyses s of health claims data ensuring alignment with base utilization assumptions and market medical services costs.
- Compile and prepare regular MIS reports regarding utilization and Medical provider costs and communicate with clients with high L/R
- Suggest enhancement business procedures ensuring maximum efficiency of processes.
- Reimbursement process handling from submitting claims until delivering payment with regular reports on TAT and transfer ratio
- Develop and implement process for detecting Fraud cases.
- Handling complaints within agreed SLA and reporting them on daily basis
**Job Qualifications**:
- Medical Degree
- Post graduate degree is a plus
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