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Claims Processing & Auditing Manager-Yemen- Aden

MasterHR.com

- Aden, Yemen
Posted In 17/11/2018
Job Description
Location: Cairo & Yemen- Aden
Job Title: Claims Processing & Auditing Manager
Reporting to: Managing Director
Responsibilities:
The Claims Processing & Auditing Manager will be responsible of the following functions:
1. Evaluation, revision and validation of claims if needed, reviewing and auditing processed claims on daily basis as per the directions of managing director.
2. Reporting the audit results and reports to the medical & claims manager.
3. Entering and processing / adjudicating claims (international claims) in company operational software system as per the terms and policy of the organization (as per the Policy Terms & Conditions & as per the Agreed Procedures per every client - payer).
4. Notification of claims shortfalls, requesting, rectifying/justifying and following up with providers (regarding International claims).
5. Maintaining both qualitative and quantitative claims measures (regarding International claims).
6. Communication with the international providers regarding the issues that belong to the batches received & processed for the international providers. Ensure the proper communication and implementation of new formats, training and processing rules as and when available (regarding International claims).
7. Perform any other tasks as may reasonably be required by your supervisor and/or manager.
8. Hiring and training staffers in the claims department and overseeing their day-to-day performance.
9. All the Targets can be Changed & Adjusted as per the Organization Strategy & Goals through the Organization Management.
Note: As a part of the first employed at our start-up company, the incumbent will be responsible of/assisting in the generation and application of test scenarios for accepting the TPA software, and will sign off on some of the modules in the software acceptance test.

If you are interested kindly send your updated CV to
Job Requirements

Experience

Min: 15 Years

Career Level

Supervisor/ Manager

Job Type

Full Time

Vacancies

10 Open Positions

Salary

Negotiable

Gender

Any

Degree Level

Any

Faculty / Institute

Any

Major

Any

Age

Any

Nationality

Egypt

Residence Location

Egypt

Languages

Any

Own Car

Any

Own Driving License

Any

Job Skills
Qualifications:
1. Physician.
2. 7-10 years of experience in management and claims / medical reports and hospital bills management experience.
3. Preferred: multinational medical experience.
4. Preferred: with insurance company and third-party administration (TPA).
5. Priority: has actually worked in insurance
6. Preferred: Master degree and/or worked as GP or emergency doctor.
7. Excellent written and spoken English & Arabic, and excellent computer skills.
About The Company

Master HR (Recruitment, HR Consultation Services, Training, Development & Outsourcing).
Job vacancies for all careers
license No. '432', since 2001.
01000006540

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