Jobzella team will participate in the Load More...
• Documents 1. Be aware of each policy, table of benefit and exception for each client to ensure the proper processing of the claims. 2. Ensure the competence of the documents of each claim according to claims processing procedures and ensuring that all the needed information is valid. 3. Verify the beneficiary’s information, handle the claim forms and analyzing them starting from arrangement till checking them for validity. 4. Report on daily, weekly and monthly basis the productivity which identifies the work achievement and report any inquiries regarding approvals or contracts or price lists to the concerned departments. • Medical 1. Revise the medical procedures with the diagnoses to check whether justified and correlated medically. 2. Ensure that the medical provider sticks to the operation procedures and card instructions for example: approvals are obtained if needed. 3. Differentiate between Chronic, critical, preexisting, acute and other cases based on the table of benefit and policies to ensure the alignment with the set limits. 4. Review the medical history of each beneficiary to ensure the validity of the diagnosis and the procedures. 5. Match the diagnosis, provider medical procedures and ICD codes (International Classification of Diseases) on the system with the medical history of the patient confirming adherence and correlation. • Financial 6. Ensure the adherence of the claimed amounts to the medical procedures provided to the beneficiary who is already requested from the physician. 7. Review the price of the medical procedures and compare it with the stated price lists to ensure that they are financially aligned. 8. Ensure that the agreed discount and co-payment are applied from the provider side according to the contract, operation procedures and the medical card instructions.
Provide first level support for production issues across multiple applications, including problem identification, definition and implementation of short-term work around and coordination of long term software solution IT team and software suppliers. Ensure that the business application systems supported by the software suppliers are maintained to the highest possible standard with maximum levels of attainable productivity and efficiency. Working continuously on a task until completion (or referral to third parties, if appropriate). System configuration, scripting and new user administration as required Business Support provide user training and training materials and arrange third party training. Diagnose and resolve day-to- day live system issues in timely manner based on their severity. Maintain ongoing communication with end-users, Senior application support, QA team, and development team (software supplier) on reported issues. Data migration and testing. Test configuration changes in a test environment prior to pushing into production
Jobzella mobile app for Android and iPhone