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Healthcare Associates (For Pooling)
1 Year or Less
With business certificates
6F EBloc 2 Bldg, W Geonzon St, IT Park, Apas, Cebu City, Cebu
Posted On: April 13, 2021
Job ID: 376450
- Bachelor’s degree graduate of Nursing or any health-related courses
- At least 6 months CSR experience preferably with a life insurance account
- Excellent English skills in both verbal and written
- Willing to work on holidays, weekends, shifting schedules and extended working hours
- Providing support to the claim managers and client team in the promotion of quality claimant outcomes, to optimize claimant benefits, and to promote effective use of resources.
- Supporting the procedures that ensure adherence to policies and claimant benefits in providing service that is appropriate, high quality, and cost effective.
- Managing incoming or outgoing telephone calls, emails, and/or faxes, including triage, opening of cases and data entry into client system
- Determining contract; verifies eligibility and benefits.
- Adhering to federal and state regulatory and/or client plan requirements and established workflows
- Obtaining information from claimant or other supporting systems, emails and/or from fax. Manages claims, collection of non-clinical information needed for review from claimants and providers, utilizing scripts to screen basic and complex requests.
- Maintaining and updating systems to accurately reflect leave status and ensure appropriate documentation exists.
- Conducts outbound scripted calls to claimants and providers to request for clinical information.
- Identifying restrictions and limitations based on physiological, psychological, and social factors to assist claim management staff in their claim handling activities, validating the medical necessity of limitations and/or restrictions with clear rationale, providing claim management staff with medical insight and education to assist them in determining appropriate determination, and discussing medical issues and documents outcomes of discussions.
- Ensuring team compliance to client requirements and reports suspected compliance issues to the compliance department.