Insurance Doctor
Current• Evaluate and process claims in accordance with insurance policy, terms and conditions and procedures. Review medical reports and ensure proper entry and compatibility with the services provided by the hospital.• Check the accuracy of medical information with supporting documents (i.e. Laboratory, Pharmaceutical, Radiology, etc.). Communicate with the treating physician/medical team for any clarification or completion of missing information.• Escalate pending cases to the concerned department and follow-up directly with Medical Services. Coordinate and follow-up with the approving officer/s discrepancies in the official form.• Participate in establishing, developing and implementing guidelines to evaluate and process medical claims.• Collect sufficient information for each issue and escalate it to the concerned department. Provide professional advice to subordinates on all aspects of medical insurance practice and law. Assume the responsibilities of Claims Analyst as and if required.• Prepare and present necessary reports and correspondences as required by the Executive Management and Senior Executive Management.• Perform other job related duties.
