Medical Claims Advisor
Title:
Medical Claims AdvisorType:
PermanentStart Date:
ASAPSkills:
Relevant skills
Medical Claims Advisors are required to have or develop all the following areas of expertise:
Strong customer focus with excellent verbal and written communication skills
A positive, helpful attitude and willing to work co-operatively with other members of the team
Previous experience of the medical insurance industry and claims processing would be an advantage.
PC skills with good knowledge of Microsoft packages.
The ability to demonstrate customer led thinking.
Highly adaptable, with a flexible approach to work,and be willing to do what is required to ensure that the team achieves its objectives while remaining focused on quality
A pro-active approach to work and analytical, problem solving skills.
The ability to plan and organise own workload, and work well under pressure.
The ability to work well both independently and as part of a team.
Description:
Responsibilities:
- Support medical case managers with claim handling from member referral through to discharge, including issuing pre-authorisation of eligible claims
- Answer incoming calls quickly and within agreed service standards, providing a high level of customer service at all times.
- Deal with provider queries or requests in relation to clinical treatment or pre-authorisation requests
- Process invoices received in-line with agreed service standards, member benefit limits and policy terms and conditions
- Issue pre-authorisations in line with agreed authority levels, with escalation to the relevant Case Manager where appropriate.
- Assist Medical Case Managers in the management of ongoing or high costs claims
- Manage Claims administration reminders and outstanding actions
- Assess invoices received to ensure costs are in line with provider contract terms
- Adhere to all internal processes and procedures at all times
- Maintain and document accurate records on our Case Management System to include: all invoice or claim related payments, and all communication with members and providers
- Audit all provider invoices in line with the Company Reasonable & customary rates (where appropriate)
- Escalate any complaints or call backs in a timely manner
