Claims Processing Officer Nextcare Egypt

What you do

• Audit and process all kinds of providers bills.
• Screen claim documents
• Ensure that proper pricing is applied for bills before processing them in TATSH.
• Process claim adjustment.
• Apply AI-based screening techniques to ensure that insurance claims information is entered into the system correctly, to ensure accurate processing and timely delivery to payers.
• In charge of checking all required fields on TATSH to ensure accurate processing such as visa notes, precertification centre notes, contract notes, policy file, medical file, faxes, etc.
• In charge of processing and recording details of the invoice on TATSH in accordance with policy terms and conditions, product, TOB, and other information as relayed by the medical auditor and provider and/or the other relevant details as gathered by the Precertification officer.
• Daily follow up on pending claims/issues with concerned departments until problem resolution.
• Inform Network department when receiving a jumbo claim as per agreed procedure in order to obtain a special discount from providers.
• In charge of reporting in writing to the Network department regarding any deviation from the provider concerning the application of the agreed tariff
• In charge of reporting in writing to the Team Leader/Manager regarding complaints received by the Claims Processing department and relating to payers/providers invoices
• In charge of reporting in writing to the Team Leader/Manager regarding any information/task required from other departments
• Follow and apply the internal procedures of the Department
• Responsible and accountable for the confidential, proper administration of insured member data as well as system, policy and medical information
• Any other duties as requested by the Direct Manager

What you bring

• Education: Pharmacy Degree
• Experience: 2+ years experience within the Health Care Industry (TPA s, Insurance companies, Hospitals, Medical Centers)
• Demonstrate commitment to producing output base results
• Ability to respect deadlines
• Excellent team player.
• Excellent communication and organizing skills
• Flexible and ability to work shift
• Willing to work overtime when requested.
• Basic knowledge of MS Office applications