Sr. Medical Claims Executive
About the role
Prepare, maintain, and update insurance-related data and documentation as per the requirements of each insurance company.
Review and validate claim forms, prescriptions, invoices, and supporting documents to ensure claims are processed in accordance with insurance company policies and guidelines.
Coordinate with pharmacists and other relevant stakeholders to obtain corrections and required documentation in cases of claim discrepancies or non-compliance.
Monitor claim processing activities and ensure timely submission to avoid claim rejections and delays.
Consolidate and reconcile all processed insurance claims on a monthly basis for each insurance provider.
Prepare and submit consolidated claim reports and supporting data to the Accounts Department within the prescribed deadlines.
Process direct submissions for insurance providers such as Al Koot and QLM through their respective insurance portals after obtaining approval from the Accounts Department.
Coordinate with Front Office Executives for the final upload and submission of claims related to other insurance companies.
Track claim status, follow up on pending claims, and assist in resolving claim rejections, resubmissions, and queries raised by insurance companies.
Maintain accurate records of submitted, approved, rejected, and pending claims for reporting and audit purposes.
Ensure compliance with company policies, insurance regulations, and confidentiality requirements while handling patient and claim-related information.
Generate periodic reports and provide updates to management regarding claim performance, submission status, and outstanding claims.
ICD 10 & MOPH Drug coding verification: Review and confirm codes coded by Pharmacists prior to MDS submission to ensure accuracy and compliance.
TOB (Table of Benefits) Maintenance: Prepare and update a consolidated TOB by insurance company to support coding team and pharmacists in quick reference and decision-making.
Rejections and Resubmissions: Analyze denied claims, perform corrections, and handle timely resubmissions.
Reporting & Insights: Generate monthly performance reports on claim outcomes, rejection trends, and overall insurance metrics for management review
Pharmacist Support: Provide timely support to pharmacists regarding insurance-related queries and clarifications.
Compliance & Updates: Stay updated on insurance company policies, implement necessary changes, and ensure pharmacy compliance.
Manage and guide back-office coders to ensure standardization, efficiency, and quality control across all locations
Manage and update login credentials for all insurance portals, including Al Koot Insurance & Reinsurance Company, QLM Life & Medical Insurance Company, GlobeMed, AXA Insurance, Nextcare, and Allianz, ensuring secure access and timely updates
Maintain records of rejection trends and suggest process improvements.
Supervise junior claims executives and coordinators.
Maintain strict confidentiality related to medical records and claims related data
Learn and update policies and processes of any newly added insurance providers in the portfolio to ensure accurate claim processing and compliance
Pay: ₹25,000.00 - ₹30,000.00 per month
Benefits:
Flexible schedule
Work Location: In person
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