Medical Assistance Officer
Skills
About This Role
Overview
Manage the assigned tasks related to medical assistance cases.
Evaluate medical claims according to the guidelines.
Coordinate with different providers to ensure high quality of service when organizing medical assistance.
Respond inbound and outbound telephone / e-mail Customer / Partners inquiries and ensure call quality monitoring
Claims evaluation and processing activities such as checking policy, eligibility, claims creation in the system, follow up upon ongoing claims ensuring the requested turn around time and processing of claims and other tasks related to claims management
Assist callers on claims process / procedure / network inquiries, explaining policy terms & conditions
Accommodates Business Units / Travel / TPA International requests with regards to opening international files, placement of Guarantee of Payment, etc.
Follow the complaints & escalation management process and log in complaints with action & resolution in the system / tools provided by the company
Ensure proper system related tasks as creating files and Service Providers updates on the portal
Record tasks in the productivity file, share with management and ensure reaching the level of productivity assigned
Follow the internal processes and guidelines to ensure reaching the Operational KPIs (Quantity and Quality) and the attendance KPIs
Request feedback in relation to the performed tasks and discuss with Team Leader the monthly scorecard results
Monitor daily activities as per the communicated Service Level Agreement, create reports / statistics / analysis and report any deviation
Attend training sessions as requested and participate in the departmental activities in accordance with the monthly schedule
Attend internal meetings related to the job as per the internal requirements
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