الوصف الوظيفي
in this role you are responsible to ensure that assigned provider’s Outpatient claims will be medically & commercially adjudicated within the specified time frame and within the targeted quality standards to achieve the business objective of delivering high quality claims statements.
Key Accountabilities:
Process all the daily batches of claims assigned in line with medical policy and adjudication guidelines while using medical his/her medical background in conjunction with the instructed guidelines, day-in-day-out for smooth operation of business activity
Assure that each Outpatient claim has been processed as per the checklist of steps involving checking of physical claim (or scanned image on the document management system), and cross checking with the electronic claims data on CAESAR, and reflecting the right decision for every claim on the operations system
Achieve daily target in terms number of claims without delaying claims unnecessarily.
To achieve required quality through achieving at least 95% accuracy level on monthly quality audits, in order to maintain the quality standard set for the job.
Makes sound medical decisions that minimize the opportunity to be challenged by providers and consults with seniors where in doubt.
Reports abnormal trends of provider practice for adjudicated claims
Education:
Bachelor’s Degree in Pharmacy or Nursing from an accredited Institution
Experience Fields:
Clinical Experience
Medical Insurance Experience preferable
2 years’ experience is required
المهارات
Clinical Experience
Medical Insurance Experience preferable
2 years’ experience is required
تفاصيل الوظيفة
منطقة الوظيفة الجبيل, المملكة العربية السعودية
قطاع الشركة خدمات الدعم التجاري الأخرى
طبيعة عمل الشركة صاحب عمل (القطاع الخاص)
الدور الوظيفي الطب والرعاية الصحية والتمريض
نوع التوظيف دوام كامل
الراتب الشهري غير محدد
عدد الوظائف الشاغرة 1
المرشح المفضل
المستوى المهني مبتدئ الخبرة
عدد سنوات الخبرة الحد الأدنى: 2 الحد الأقصى: 2
منطقة الإقامة المملكة العربية السعودية
الجنس ذكر
الشهادة بكالوريوس/ دبلوم عالي
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