Medical Assessor – Insurance Approval – WARBA Insurance – Kuwait

Position Summary:

Primary point of contact for the customers for all aspects related to pre-approvals/health benefits/claim status and other queries

Roles and Responsibilities:

o   Assess and Analyze clinical information and medical evidences presented by medical providers

o   Respond, approve or reject medical claims based on the policy holder table of benefits in a timely manner

o   Give verbal and or written justification in case of rejection to provider and or policy holders in a professional manner

o   Understand and follow the escalation matrix in case of complicated medical cases and or when the claim exceeds the authorized limit

o   Communicate with customers through calls / emails and assist them with their inquiries.

o   Redirect calls / emails to the concerned departments.

o   Identify customer’s needs, clarify information, research every issue and provide solutions and/or alternatives

o   Keep records of customer’s complaints/suggestions/comments, as well as actions taken

o   Managing large amounts of inbounds and outbound calls in a timely manner

o   Maintain the required quality for the process (Greeting – Phone Etiquette – Transferring Calls)

o   Following communication “scripts” when handling different topics

o   Ensure accuracy of the information provided to customer, request support from team leader if required

o   Report cases that requires further follow-up by supervisor and keep customer informed with feedback

o   Escalates customer issues and complaints to CSM within 24 hrs using proper documents to address the issue.

Job Details

Posted Date: 2020-01-20
Job Location: Al Kuwait, Kuwait
Job Role: Medical, Healthcare, and Nursing
Company Industry: Healthcare, other

Preferred Candidate

Career Level: Mid Career
Degree: Bachelor’s degree

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