Position : Senior Claims Officer

Section : Medical & Life Insurance

Company : Al Koot Insurance & Reinsurance Company

Location : Doha, Qatar

Experience : 10– 12 Years relevant experience

No of resources : 1

Purpose: To supervise and manage the Claims function, obtaining the required information from the insured members and assessing their eligibility, in order to settle claims in an effective and efficient manner.

Job Summary :

• Evaluate claims of patients against policies and coverage information, and discuss the more complex ones to line manager in order to settle them as per established policies.
• Ensure that proper and complete instructions on claim eligibility are provided on pre assessment sheet for proper and timely settlement of the claim.
• Supervise the claims processing and ensure all claims team are following the claims policy and procedure.
• Conduct regular team training to improve the claims performance.
• Ensure all records are kept in order as per the department policy and procedure.
• Conduct periodic internal audit to monitor the quality of the claims processing
• Monitor the claims TAT and ensure that the claims process are within the agreed TAT
• Distribution of workload to the team members based on the experience of the team members.
• Maintenance of Productivity and QC Reports for the team
• Periodic review and evaluation
• Annual performance appraisal of the department
• Adherence to regulatory requirements
• Interdepartmental Coordination
• Ensuring error free processing of preauthorisation within agreed TAT (Turnaround time).
• Ensure high accuracy of all the authorization approval as per the process.
• Approving high value Pre-Auths and if there are any escalation from the team members.
• Escalating to the direct line manager for extreme complex cases.
• Solving customer queries wherever medical opinions are required and need to be address by the medical practitioner
• Make sure the internal processes and regulatory requirements are met and maintained with fewer complaints by the team

Skills

Knowledge & Experience :

• University Degree
• 10– 12 years of experience (preferably relevant experience)
• Sound medical knowledge and willing to work in non-clinic process.
• Minimum of 4-6 experience in handling authorization.
• Should be willing to work in shifts as the department works on 24/7 function

Skills & Competencies :

• Time Management
• Computer literacy
• Attention to Detail & Good Communication Skills