Claims Supervisor - Reimbursement Claims is responsible to review high-cost Reimbursement Claims, manage medical evaluations, Reimbursement Claims coverage, errors and claims turn-around-time and processors queries to achieve quality decisions and evaluations.
• Audit, evaluate, process, and validate claims, with regards to eligibility as per the company's terms and conditions.
• Communicate policy and rules to Reimbursement Claims evaluations team
• Monitor the following:
o Backlog
o Daily productivity
o Pending cases
o In-patient cases
o Claims entered in the system
o Reimbursement Team attendance details and shift schedules
o Detection of errors
o Turn-around-time of International claims
o Supervise trackers, evaluators, and processors of the Reimbursement team
• Monitor and participate in quality control reviews
• Supervise Reimbursement team claims officers on their monthly achievement and performance
• Increase efficiency by minimizing errors and administration time.
• Provide feedback to internal and external customer queries in a professional demeanor
• Deal with urgent and non-urgent situations involving insured payers/BDU
• Provide individualized administrative service and assists insured members in obtaining high quality, cost-effective healthcare
• Perform autonomous duties including Claims coverage decision requiring specialized knowledge, judgment, and skill within the guidelines of the company's policies and procedures
• Responsible and accountable for the confidential, proper administration of insured member data as well as system, policy and medical information
• Responsible for utilizing medical knowledge base, effectively collaborating and promoting collegial relations to enhance the quality and cost-effectiveness of healthcare of insured members.
• Assist in creating action plans in response to errors/audits
• As required recruit, train, and supervise staff
Internal Business Processes
• Communicate performance data as such would be related to quality/quantity aspects to allow for proper recognition of work evaluations.
• Active involvement in the implementation and continuous improvement of TAT.
• Provide feedback on their output and performance
• Develop and recommend improvement of facilities, equipment, or procedures to improve safety, quality, and efficiency
• Monitor usage of utilities to ensure efficiency; establish a culture of continuous improvement in a safe working environment
• Co-ordinate regular meetings with staff
Job Details
| Date Posted: | 2014-04-08 |
| Job Location: | Dubai, United Arab Emirates |
| Job Role: | Management |
| Company Industry: | Insurance |
Preferred Candidate
| Career Level: | Management |
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Medical Claims Supervisor - Doctor job United Arab Emirates