Medical Claims Processing Executive

Company: AXA General Insurance

• Determines covered medical insurance losses by studying provisions of policy or certificate.
• Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
• Documents medical claims actions by completing forms, reports, logs, and records.
• Provide clients with information on incomplete form entries and assist them in locating avenues to obtain them.
• Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
• Provide clients with information on incomplete form entries and assist them in locating avenues to obtain them.
• Perform follow-up services to ensure that all unpaid and selective denied claims are paid in an accurate and timely fashion
• Ensures legal compliance by following company policies, procedures, guidelines, as well as insurance regulations.
• Maintains quality customer services by following customer service practices; responding to customer inquiries.
• Prepare materials for claims audits and provide assistance to auditors during the procedure.
• Protects operations by keeping claims information confidential.
• Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

Qualification 

• Technical and Behavioral skills:
  • Knowledge of coding, billing and medical terminology, CPT, HCPCS, ICD-9
  • Strong knowledge of Medical billing & payment and coverage guidelines and regulations
  • Strong experience in the analysis and processing of claims, utilization review/quality assurance procedures and payment methodologies.
  • Must be able to work with minimal supervision.
  • Creative thinker with good skills a problem resolution specifically related to healthcare claim adjudication
  • Will work closely with other departments
• Academic Qualifications:
• Any graduate from a reputed medical institution in pharmacy or paramedic science – Medical related course.
• Have at least 1 year work experience in a similar field.

WHAT WE OFFER 

We are investing significantly in the Gulf region and we recognise the important role employees have in the success of our business.

We offer excellent opportunities for motivated and talented candidates whether at entry level or at c-suite level.

We value diversity and we encourage applicants of various backgrounds and nationalities to join our team.

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