Description:
Key Responsibilities
Medical Insurance Endorsements:
- Process policy endorsements, including additions, deletions, and modifications, accurately and efficiently.
- Verify client information and documentation to ensure completeness and compliance with insurance company policies.
- Coordinate with Insurers to obtain necessary documents for endorsement/policy changes.
- Update and maintain accurate records in the system.
- Adhere with the agreed SLA’s with respect to the turn-around-times on specific administration functions.
Medical Claims Administration:
- Assist in the initial assessment and processing of medical insurance claims.
- Review and verify claim forms and supporting documents for completeness and accuracy.
- Enter claim information into the system.
- Communicate with healthcare providers and clients to gather additional information or clarify discrepancies.
- Ensure timely follow-up on pending claims and provide status updates to clients and/or members.
- Knowledgeable about reimbursement procedures and insurer portals.
General Administrative Support:
- Provide administrative support to the medical insurance team, including preparation of documents, reports, and handling correspondence.
- Maintain organized and up-to-date filing systems.
- Respond to client inquiries via phone or email, providing accurate information and assistance.
Requirements:
- Minimum 2 years of Insurance related experience
- Work experience in a health care provider (TPA / Insurance Company)
- Professional communication skills to explain benefits plans to employees and answer queries.
- Excellent problem-solving skills while handling issues with the claims and appeals process.