Job Description

To issue online and verbal authorizations based upon member coverage & medical justification. To assist queries from providers and payers via phone calls or e-mails To maintain files for authorizations and other reports. Assessing and processing claims in line with the policy coverage and medical necessity. Be fully versed with medical insurance policies for various groups / beneficiaries. Might be required to assist in training colleagues and sharing knowledge. Able to accurately assess eligibility within the UAE (HAAD and DHA) guidelines as well as policy boundaries. Monitoring and maintaining the claims processing and adjudicating cycle in NHS operational software system as per the defined terms and policy of the organization. Establishing strategies and implementing effective parameters for solving all possible queries within the team. Taking a lead role in assuring that the assigned tasks to the team are completed within the allocated time frame. Ensures the proper communication and implementation of new formats, training and processing rules. Entering and processing/ adjudicating claims in NHS operational software system as per the terms and policy of the organization. Taking initiatives to maximize team efficiency. Maintaining both qualitative and quantitative claims measures. Ensure adherence to the predefined TATs for claims and pre-approvals Achieving required processing targets assigned by the team leader on daily, weekly and monthly basis. Monitor the qualitative and quantitative measures for claims & pre-approvals. Ensure compliance to any changes in terms of system parameters or process. Daily monitoring of pipelines and queues (not limited to claims, calls and authorizations only). Ensure the team can grasp the new process updates and accordingly implement them during the operations. Responsible in maintaining the assigned TAT of the respective teams. Identify gaps in performance and offer coaching to officers as needed. Proper communication and identifying training requirements within the team. Addressing complaints externally and internally of the concerned operational processes. Strictly applies CMO's directions. Carry out any other related functions as directed by the company management. Job Types: Full-time, Permanent Pay: AED5,000.00 - AED6,000.00 per month Ability to commute/relocate:

• Dubai: Reliably commute or planning to relocate before starting work (Required)

• Bachelor's (Preferred)

• Insurance Industry: 2 years (Preferred)