• Conducts medical audit for fraud, waste or abuse.
• Reviews a secondary Medical Approvals audit.
• Implements and manages Claims denial, approvals.
• Reviews claims which are suspected for abuse and medical claims audit.
• Reporting on daily base approvals and rejection activities.
• Highlighting the suspicious trends of the providers or doctors.
• Checking data fairly and lawfully
• Maintaining complete knowledge of and comply with all departmental policies/service, Procedures / standards.
• Processing and auditing all type of claims received by our clients, from the medical and insurance perspective.
• Reporting back any type of claims observation or issues that may affect the process.
• Assists Claims personnel in the operation
• Ensures that claims decisions are consistent, equitable and prudent, per company’s standards and practices
• Ensures that Company standards are met and kept up to date
• Assist in Home country treatments (not limited to Pakistan).
• Assist in getting best rates within the region on local discount ground.
• Establish priorities that directly relate to those department & corporate objectives;
• Work on simplifying procedures/systems, whenever necessary, in coordination with claims Management;
• Timely Service: Ensure work gets done as fast as possible; within the established guidelines regardless of whether the daily workload is heavy or light. Ensure that TurnAround time is maintained.
Bachelor’s degree holder (MBBS or MD) with practical work experience.
Working knowledge in general practices for insurance procedure within the insurance industry.
Takaful Emarat Insurance PSC, established in 2008, is a leading Shariah-compliant Life and Health Takaful Provider in the UAE. Takaful Emarat markets a wide range of individual and corporate life and health Takaful products including protection, savings and investment plans through variety of dis ...
Takaful Emarat Insurance PSC, established in 2008, is a leading Shariah-compliant Life and Health Takaful Provider in the UAE. Takaful Emarat markets a wide range of individual and corporate life and health Takaful products including protection, savings and investment plans through variety of dis ...Read More