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