Position Objective:
- Adjudicate medical reimbursement claims within TAT and ensure to detect fraud, waste, and abuse claim by using medical knowledge.
- Perform customer centricity during the claim process.
- Proactively contribute creative ideas to the team to improve team performances
Roles and Responsibilities
1. Claims Assessment (80%)
• Ensure all claim cases are assessed thoroughly and carefully and claims decisions within Claim Authority are made based on valid grounds as well as in full compliance with Claim guidelines/policies/ T&C.
• Examine patients’ medical records to ensure accuracy and completeness.
• Operate classification software to apply the correct clinical codes in system for reimbursement.
• Document patients’ health information, including medical history, examination and test results, and any treatments or procedures provided.
• Preserve confidentiality of all patient records
• Ensure to achieve claims SLA commitments to customers, distribution, and partner.
• Prepare proper documentation, and if possible, recommendation on cases referred to higher authority level or to Claim Committee for decision.
• Proactively contribute good practice, ideas to the team to improve team performance.
• Performs other responsibilities and duties periodically assigned in order to support company’s business.
2) Medical advisor: (20%)
- As a medical doctor, to be responsible for advising medical knowledge to other assessors cross other teams.
- Back up assessor, who is responsible for direct billing hotline, in case of her/his absence.
