Objective:

The job holder will be responsible for reviewing, auditing medical claims, evaluate pending claims, reconciliation & handling Pre-authorization requests with assuring excellent customer service.

1. Customers, Intermediaries and Health Care Providers - For resolving queries / issues, managing relationships, pre-authorizations and conveying information.

2. Coordinate with providers to make procedures more cost effective.

Assist in managing Pre-authorization business to optimize cost efficiencies and subject to medical & policy eligibility.

3. Assist in implementation of medical claims processes, reconciliations protocols and to communicate & clarify to clients, providers & intermediaries.

4. Review medical claims and evaluate pending claims