- Case management, handling all outpatient, inpatient, specialized services preauthorization, and
- Communicating with providers, clients, and brokers on a timely basis.
- Efficient & accurate submission of approvals in line with the medical policy.
- Obtaining medical information from providers with written correspondence if necessary.
- Capacity to continually apply negotiation skills with the service providers.
- Interacting with clients, Intermediaries and services providers as required to resolve problems in a manner that is legal, ethical, and consistent with the principles of the policy.
- Accurate checking and confirming membership validity, benefits and sending member statement upon enquiry.
- Accurate guidance on provider network enquiries from brokers, providers, members etc.
- Vetting and confirming validity of the service given by the service provider in relation to the member benefit covered, treatment given, adherence to provider panel rules and cost of treatment.
Relevant Experience & Qualification
- Bachelor’s degree/Diploma in nursing or other related medical field
- At least one (1) years’ experience in a similar role in the insurance industry / hospital facility
- KRCHN Registration
- Further Education and Training Certificate (FETC): Business, Commerce and Management Studies (Required)