Consultant Medical Rejections
Kuwait, Kuwait
Job Description
Designation: Consultant Medical Rejections Reporting to: CFO, and would be working in collaboration with the Insurance Unit In-Charge Team: None Interaction: Insurance companies, Medical Admin, Doctors, Insurance unit, Accounts & CSD
: Support the process, in collaboration with the Insurance Unit in-charge, of systematically investigating each denials, performing root cause analysis of why each claim was denied, analyzing denial trends to uncover a trend across insurance companies and re-engineering the process to reduce future rejections. Key activities involve:
Immediate tasks: Would be to review overall rejection management process with special focus on medical rejections, assess key interaction points and activities, deep dive into our current medical rejection trends, and identify areas of improvement and upcoming challenges given the evolving ways of working of the insurance companies.
: Support the process, in collaboration with the Insurance Unit in-charge, of systematically investigating each denials, performing root cause analysis of why each claim was denied, analyzing denial trends to uncover a trend across insurance companies and re-engineering the process to reduce future rejections. Key activities involve:
- Joint responsibility for reducing the medical rejection rates: Investigate the reason for every denied claim, focus on resolving the issue, resubmitting the request to the insurance company and filing appeals where required and liaising with the doctors on fixing the claims;
- Supporting CFO with the needed inputs for final settlements and reconciliation of the rejected claims;
- Guiding and supporting medical claim officers and ensuring timely re-submission of claims to the insurance company as per assigned schedule and target dates;
- Liaising the quarterly and annual audit reviews from the insurance companies and resolving for any possible financial implications;
- Reviewing pre-approval rejection trends and identifying areas of improvement to minimize opportunity loss.
- Organizing and supporting departmental meetings, trainings and educational programs;
- Process and workflow automation. Reduce efforts to check the claims\' status by improving the adoption of web portals to obtain claim status online. Defining claims follow-up work queues with web-based workflow systems that improve the documentation quality;
- Keep self and the function abreast with the best practices, market intelligence and latest developments on controlling rejection management.
Immediate tasks: Would be to review overall rejection management process with special focus on medical rejections, assess key interaction points and activities, deep dive into our current medical rejection trends, and identify areas of improvement and upcoming challenges given the evolving ways of working of the insurance companies.
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Job Detail
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Job IdJD1526570
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IndustryNot mentioned
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Total Positions1
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Job Type:Full Time
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Salary:Not mentioned
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Employment StatusPermanent
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Job LocationKuwait, Kuwait
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EducationNot mentioned