·To contain cost by performing quality assurance assessments of services within a
healthcare system involving financial, logistical, patient services and health
management systems.
·To investigate, analyze medical files for specific cases when needed with
providers.
· To uphold the company’s ethics, operating
policies and conform with the department work instructions.
·Evaluates the approval request in terms of
medical necessity and consistency of diagnosis, procedure and medicine codes
with the international medical guidelines / practice.
·Evaluates the approval request in accordance
with policy terms and conditions.
·Ensures accurate payments in accordance with
the contract, SOA, correct allocation of benefits and adherence to claim
submission guidelines.
·Acquires the required technical skills to process
claims through the system.
·Achieves daily targets effectively and
efficiently.
·Ensures the best quality in claims auditing
and escalates the observations about providers’ trend to the Supervisor /
Manager.
·Detects fraud and abuse and recommends steps
to prevent similar incidents.
·Communicates with healthcare providers in all
acts.
·Contributes in developing, updating and
implementing the medical guidelines.
·Contributes in developing, updating and
implementing the rule engine.
·Assists in any other capacity as required by
the Line Manager.
Job Details
| Posted Date: | 2019-03-26 |
| Job Location: | Al Kuwait, Kuwait |
| Job Role: | Medical, Healthcare, and Nursing |
| Company Industry: | Insurance |
Preferred Candidate
| Career Level: | Mid Career |
| Degree: | Bachelor's degree |
To apply for this job click here
Jobs in Kuwait - career in Kuwait - vacancies in Kuwait-Medical Approvals Advisor - Gulf Insurance Co.-Jobs in Kuwait - career in Kuwait - vacancies in Kuwait
Post a Comment