THE JOB
Processing and validating insurance claims, resubmissions, reconciliation and empanelments.
Job Description
Insurance Submission/Denials/Re-submissions/Remittance:
- Validating claims and submitting E-claims on DHPO/Shafafiya portal as per DHA/DOH/MOH guidelines on a timely manner
- Reviewing and analyzing of Remittance advice
- Recording of fully paid, partly paid and denied claims
- Reviewing and re-submitting of denied/partly paid claims with accurate reason
- Liaising with payer/TPA regarding remittance follow-up, resubmission, reconciliation and other requirements
- Finalizing yearly book closures with Insurance TPA/Payers
- Tracking & maintaining sales report for direct billing and reimbursement store wise
Insurance Empanelment:
- Arranging the required legal documents
- Empaneling individual branches/stores for Insurance direct billings
- Coordinating with new/existing Payer/TPA for pending/new contracts
- Maintaining store wise Empanelment summary for direct billing and reimbursements
- Initiating addendums with new changes in terms/tariff
Profile
- Preferably a Graduate with 2-3 years of relevant work experience
- Strong Attention to detail
- Advanced skills/proficiency in MS-office (Excel & Powerpoint)
- Excellent verbal and written communication
- Good time management skills
- Proficient in systems
- Good Interpersonal skills
- Ability to work under pressure and stringent timelines
