Senior

• 2014 - Present

MCC Officer

• Jun 2014 - Present

Currently Working at MedNet as MCC Officer, my roles and responsibilities are-Evaluate claims (Network & Direct) and provide authorizations for insured members (in-patient & outpatient). -Handle calls relating to medical cases efficiently. -Assess risk exposure of members in line with medical underwriting policies. -Manage queries from providers, Insurance Companies and insured members relating to claims processing, evaluation and administration. -Provide medical guidance to the Claims Department staff and assistance in ICD coding. -Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction. -Client Management / attending hospital visits to investigate on claims in order to minimize fraud and abuse. -Compile data and prepare monthly statistical reports to monitor departmental performance and medical trends. Show less

Reimbursement processor/ Call Center Executive

• Dec 2012 - Nov 2014

Worked as claims officer for 1 year and promoted to Re-imbursement processor / call center executive. i personally handle -Processing reimbursement claims within UAE and outside UAE based in geographical scope of coverage as per policy. -Adjudicating reimbursement claim as per policy terms and condition. -Provide timely processing and adjudication of claims. - Attending to queries from Members and policy holders in resolving problems that result from claim settlement. -Performing audit of randomly selected claims to ensure quality processing and detect any frauds. Following adjudication policies and procedures to make sure proper payment of claims -Providing timely and quality customer service to members and policy holders -Processing claim forms, adjudicate for provision of deductibles, co-pays, co-insurance maximums and provider settlements Show less