The job holder will be responsible for handling Pre-authorization requests with assuring excellent customer service. Provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of the cases.
Roles and Responsibilities
- Answer all incoming calls related to Inpatient authorizations following the Company guidelines and protocols. In case of call queues handle OP calls as well
- Reviews case records and reports, collects and analyzes data, evaluates client’s medical status and defines needs and problems in order to provide proactive case management services
- Handle incoming client/provider emails for ongoing/escalated IP cases
- Facilitate and complete the administrative and demographic portion of the Pre-authorization screen module for each request received from the provider/ clients / members
- Handles escalated calls from Executives of the Medical Authorization OP and IP team that require an intervention and ensure a resolution is achieved.
- Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by various insurance policies
- Work the Case Managers and Sr. Medical Authorization Consultants who in turn will liaise with medical providers and suggest cost effective treatment alternatives, when appropriate.
- Ensure Service Level Agreements (SLA) of the client is met for based on the contractual agreement.
- Maintain a good knowledge of service provided by Neuron, including Medical insurance policies and the network of hospitals, clinics and pharmacies provided
- Continuously strive to improve the processes and ensure high level of customer satisfaction and meet all the service level agreements set by our clients and the company.
- Comply with established Best Practices
- Graduate – Medical Qualification (MBBS Doctor)
- Familiarity with medical terminologies
- Excellent command over English (both verbal and written)
- Strong Customer Service Skills
- Ability to work on your own initiative and as part of a team
- Ability to prioritize work
- Problem solving skills and ability to generate solutions
- Prior experience in Insurance industry preferably TPA
|Job Category||Call Center, Clients Support|
|Job Id||MAY 001 MAIP/CS/ORG|
|Career Level||Mid Level|
|Years of Experience||Minimum 2 Years|