تفاصيل الوظيفة
Basic Function and Principles
Answer all inquiries, identifies, segregates and registers the pre-approval requests. Maintain and file the related insurance contracts. Photocopy documents and types of correspondence. Assist in the input of data information, check of authorization, and production of reports and statistics.
Perspective Roles and Responsibilities
Financial:-
Identify any general incorrect or missing information, application or incorrect stamps and informs the Supervisor/ Manager for action.
Customer:-
Answer all inquiries from In/Out-Patient parties regarding coverage under the specific policies and ensure compliance with them.
Receive pre-approval correspondence, documents, requests and forms. Check and segregate them.
Internal Process:-
Register the incoming correspondence and requests, as per procedures. Input the details information in the computer system.
Retrieve the related contacts, record, form and service conditions and input the information in the
approved forms.
File, store and protect all references data and correspondence for ease of retrieval
Prepare reports and statistics.
Comply with established procedures and work instruction.
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Work Contacts
Minimal contact internally & all the network parties
Manuals and Procedures Related to Position
Work Procedures related to own department workflow.
All contracts and policies signed with the various parties (hospitals, pharmacies, labs, self-insured funds)
Work Environment
Office work, Air-conditioned environment.
Physical Effort
Minimal Physical effort.
Work Experience
Minimum 1-2 years of experience
Educational Qualifications
General Practitioner Doctor (GP)
Key Performance Indicators, KPI’s
Percentage of errors in approvals compared to the policy
SLA of response Time
Handling cases independently and giving approvals with minimal reference to the manager.
Number of calls answered vs. missed calls
Average per call handling