• Understand and comply with network agreements between Insurance Companies and UHS.
• Verifying the requests from doctors based on the medical conditions and determine whether requires preapproval.
• Maintain record of approvals for requests that require approvals and update them frequently.
• Processing claims in the system on daily basis (If required).
• Auditing the invoices before sending to Insurance Companies.
• Coordinating with Insurance Companies for queries related to medical approvals, claims etc
• Reconciling the claims that are short paid/ rejected with valid medical reports.
• Coordinating with doctors for medical reports and queries from Insurance Companies.
• Liaise with patients and explain approval or rejection.
• Undertake all calls regarding approvals from patients and provide appropriate replies.
• Undertaking the approval and Insurance companies/sponsors as may be applicable.
• Communicate with patient for approval/rejection status of approvals from sponsoring agency (including Insurance).
• Communicate with Insurance companies/sponsors and provide required clarification/do follow up of cases.
• Prepare cost estimate (if assigned) to be sent to insurance companies/sponsoring agencies.
• Comply with jobs that are additionally assigned by manager from time to time.
• Bachelor Degree
• 2 years experience in health insurance.
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