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• Pre-Authorization of Cashless and reimbursement request & Claims scrutiny or reviewing claims files in light of policy T & C of various insurance companies.
• Interaction with Health Care Providers & Coordination with internal - external teams in processing the cases .
• Medical scrutinizing, assessing and admissibility of medical claims, (Indian Subsidiary of WAPMED-Kuwait, Dubai, Abudabhi).
• E-Claims (Electronic Claims ) - these claims are receiving from Dubai and Abu Dhabi & Medical scrutinizing of these claims which comes in ICD-9 and ICD-10 format & CPT Codes Standardized by DHA, HAAD & following the guidelines pertaining to Insurance Companies of Middle East like Al Ain Ahlia Insurance Company, INTERGLOBAL, AETNA, WARBA, RITAJ, Takaful Emarat Insurance etc.
• Paper / Physical Claims – from Kuwait – which comes in PDF format & Process claims as per healthcare guidelines by maintaining daily productivity.
• Well versed in proceeding of reimbursement claims of DHA HAAD & Indian Insurance claims.
• Commercial audit, Medical audit of claims and raising IR (information required) & issuing for PR (payment request).
• Generating claim IDs for data processing & thorough knowledge regarding claims validation & in final audit.
• Knowledge of policy concepts like Deductible, Coinsurance, Co-pay, and following plan guides for referring Policy benefit Exclusions in processing of claims.
• Continuous Quality improvement in Health Claims Processes & Maintaining TAT (Turn Around Time) for claims settlement.
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