Key Responsibilities:
♦ Issues permission slips to OUT patients for medical services to be carried out at SGHUMC or at other affiliated hospitals. Check the insured card, ID and refers to the insured online file to verify validity and entitlements and issues permission slips accordingly.
♦ Processes official papers for IN patients’ stay in hospital or at other affiliated hospitals to allow insured receive medical in – hospital treatment. Includes referring to patients’ files verifying validity of policy and entitlements, filling admission forms, getting approval from the supervisor and informing the patient.
♦ Performs data entry duties for all admission and discharge forms to update patient’s file.
♦ Receives all the bills, and file them in claims file. Analyses bills ensures all charges are correct and according to entitlements and update claimers records.
♦ Reviews policies for renewal at maturity date. Refers to files, determines new exclusions base on claims submitted and informs underwriter of details.
♦ Reviews claimers debts, balances due, before admitting to hospital for treatment to ensure that premium was fully paid. Informs Medicard Cashier/Collection of insured dues to arrange settlement or insure approval of admission.
♦ Reviews status of in-patients with treating doctor in affiliated hospitals to ensure that patients do not exceed their stay and remain within their insured limits.
♦ Performs other similar duties such as sending patients gifts on special occasion, making courtesy visits to in – patients to insure satisfaction, etc.….
♦ Prepares monthly summary reports on IN Patient, OUT Patient and ER claims, Paid and O/S, Hotline operation, approved and rejected claims and Loss Ratio reports.
♦ Performs any other task requested by the Manager.
Job Requirements:
♦ BS Nursing
♦ Minimum 3 years of experience on the Third-Party Administrator (TPA) claims processing, or insurance companies’ in-house claims handling
♦ Good Language knowledge of Arabic and English, French is a plus
♦ MS Office skills especially Excel
♦ ICD 11 Nomenclature
♦ Good communication skills
♦ Problem solving Skills
