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Senior Medical Claims Representative
Hazmiyeh
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General Information
 Senior Medical Claims Representative needed for a leading insurance company in Beirut, Lebanon.

Job Requirements:

  • Bachelor’s degree preferably in a paramedical field
  • Minimum 5 years of experience in the insurance field.
  • Good knowledge in the use of Microsoft Office applications
  • Strong organizational skills and the ability to give attention to details
  • Strong ability to perform duties under pressure and perform multiple tasks simultaneously
  • Strong ability to accept and learn new ideas, and take up new responsibilities
  • Willingness to work a flexible schedule

Job Description:

  • Ensures proper implementation of the Medical Department Policies and Procedures and recommends changes for improvement.
  • Receives weekly direct claims bordereaux from the TPAs.
  • Reviews and Controls claim by claim in accordance with the Bordereaux summary
  • Confirms the validity of the TPA Claimed amount for the Medical Manager's settlement approval.
  • Processes Reimbursement claims on the TPA System and issues the related bordereaux for payments to the adherents.
  • Follows-up with the TPA on In-Hospital reimbursement Claims.
  • Answers all claims calls, processing, approvals & complaints.
  • Refers to his/her superior for problem-solving, and any special approvals or Ex-gratia requests.
  • Prepares monthly summaries by Group, Individual; By Coverage and by Class.
  • Coordinates with any regulator representative for approvals (if applicable).
  • Processes Closed Claims Data Entry on the system.
  • Sends to HO Medical Department, the monthly Direct & Reimbursement Claims Bordereaux: Incurred, Closed, Paid, Outstanding Excel Summary on a monthly basis
  • Processes the Monthly Reconciliation of the TPA on the System and the Department Excel Records.
  • Follows-up with the Accounting Department for TPA and Adherents claims payments.
  • Handles reporting and updates of Court Cases.
  • Prepares reporting reserves.
  • Secures releases from TPA on yearly basis.
  • Handles all the filing related to his/her job.
  • Enhances professional growth and development through participation in educational programs and training sessions.
  • Assists in the orientation and on-the-job training of new employees and trainees.
  • Performs other related duties as assigned or requested by his/her direct superior
  • Maintains close, cooperative and professional contact with all departments, and attends to their inquiries promptly and efficiently
  • Prepares any other document/report that is requested by the HO or the Department Team Leader
  • Enhances professional growth and development through participation in educational programs and training sessions
  • Assists in the orientation and on-the-job training of new employees and trainees
  • Complies with the Code of Conduct
  • Carries out any other assignment as required by his/her superior
Company: Expertise Recruitment
Location Hazmiyeh
Date Posted: Jan 24, 2019
Salary: Unspecified
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