Senior Medical Claims Representative


General Information


Company:
Expertise Recruitment
Job Type:
Health Care/ Pharmaceutical
Location:
Lebanon - Beirut
Date Posted:
Feb 03, 2019
Salary:
Unspecified
Employee Type:
Full-Time Employee
Gender:
Both

Description


Senior Medical Claims Representative needed for a leading insurance company in Beirut, Lebanon.

JOB REQUIREMENTS:
• Bachelor’s degree preferably in a paramedical field
• Minimum 5 years of experience in the insurance field.
• Good knowledge in the use of Microsoft Office applications
• Strong organizational skills and the ability to give attention to details
• Strong ability to perform duties under pressure and perform multiple tasks simultaneously
• Strong ability to accept and learn new ideas, and take up new responsibilities
• Willingness to work a flexible schedule

JOB DESCRIPTION:
• Ensures proper implementation of the Medical Department Policies and Procedures and recommends changes for improvement.
• Receives weekly direct claims bordereaux from the TPAs.
• Reviews and Controls claim by claim in accordance with the Bordereaux summary
• Confirms the validity of the TPA Claimed amount for the Medical Manager's settlement approval.
• Processes Reimbursement claims on the TPA System and issues the related bordereaux for payments to the adherents.
• Follows-up with the TPA on In-Hospital reimbursement Claims.
• Answers all claims calls, processing, approvals & complaints.
• Refers to his/her superior for problem-solving, and any special approvals or Ex-gratia requests.
• Prepares monthly summaries by Group, Individual; By Coverage and by Class.
• Coordinates with any regulator representative for approvals (if applicable).
• Processes Closed Claims Data Entry on the system.
• Sends to HO Medical Department, the monthly Direct & Reimbursement Claims Bordereaux: Incurred, Closed, Paid, Outstanding Excel Summary on a monthly basis
• Processes the Monthly Reconciliation of the TPA on the System and the Department Excel Records.
• Follows-up with the Accounting Department for TPA and Adherents claims payments.
• Handles reporting and updates of Court Cases.
• Prepares reporting reserves.
• Secures releases from TPA on yearly basis.
• Handles all the filing related to his/her job.
• Enhances professional growth and development through participation in educational programs and training sessions.
• Assists in the orientation and on-the-job training of new employees and trainees.
• Performs other related duties as assigned or requested by his/her direct superior
• Maintains close, cooperative and professional contact with all departments, and attends to their inquiries promptly and efficiently
• Prepares any other document/report that is requested by the HO or the Department Team Leader
• Enhances professional growth and development through participation in educational programs and training sessions
• Assists in the orientation and on-the-job training of new employees and trainees
• Complies with the Code of Conduct
• Carries out any other assignment as required by his/her superior

Company Profile