Medical Insurance Claims Specialist

Work from home (Remote 100%), Egypt

Job Type

Full time/Remote (Until office in Cairo is ready)

Interested? 

About the Role

International e-healthcare/software company is seeking 3 insurance claims specialists to join their professional team in Cairo, Egypt!

Job Details

Key Responsibilities

  • Review approval requests and provide decision based on policy guidelines and customer

  • needs within set turnaround time and accurately check the service description codes and

  • benefit matching stated on the prior authorization requests, according to accepted medical

  • coding rules, medical guidelines and policy’s schedule of benefits..

  • Monitor utilization rate and early detection of fraud and control.

  • Respond to inbound phone calls and generate outbound calls to confirm high response rate

  • % according to preset KPIs and SLAs.

  • Respond to all clients’ queries though Fax, email, phone calls etc.

  • Responsible for second opinion cases and case management.

  • Manage queries from providers, Insurance Companies and insured members relating to call

  • center activities and approval.

  • Provide medical guidance to the Claims Department staff and assistance in ICD coding in

  • coordination with Network Department.

  • Deliver excellent customer services to Insurance Companies and insured members with view

  • of achieving maximum client satisfaction.

  • Attend night shift duty to sustain any issues and queries related to Authorization department


Requirements

  • Bachelor's degree of Medicine and Surgery

  • 2-3 years of experience in their educational field

  • Previous experience in the insurance field is a plus

  • Fluent English language

  • Excellent verbal and written communication skills

  • Time management skills

  • Analytical and problem-solving skills

  • Ability to handle stress

  • Decision Maker

Company Industry

Interested? 

E-Healthcare/Software