MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Senior Claims Officer who will process and audit all medical claims efficiently and accurately according to scope of coverage and provider contracts / SOPs of payers and policy holders.
Your Job
- Processing the batches according to the agreed TAT and assigns them to the team.
- Ensures auditing of claims as per pre-defined targets and within the agreed TAT.
- Audits claims in line with Medical Justification, Standard Exclusions, Network provider contracts & as per the policy and procedures of claims department.
- Ensure that corrections are done as requested by the direct auditor.
- Build rules for automating the process and works in close coordination with Team Leader and Manager on the automation process.
- Reports Fraud and Abuse trends from Network providers or for Insured members within the batch to MNU in house team.
- Coordinates with MNU in house team on a daily basis for tasks related to but not limited to assignments, corrections, suspension resolutions and audits.
- Coach the team for change in policy & procedures, Impact of new packages on processing, coding ICD or CPT related queries in terms of billing.
- Reporting and closure of batches after checking the amount with the SOA.
Your Profile
- Bachelor's degree of Medicine is a must
- 2-4 years of experience.
- Previous experience in the insurance field is a plus.
- Fluent English language
- Excellent verbal and written communication skills
- Time management skills.
- Attention to details.
- Analytical thinking.
- Ability to meet tight deadlines.
