Register Policies in the system with proper eligibility, add Members/dependents and create appropriate tasks that will trigger proper workflow
Documentation of all calls or communications in the Members record (when applicable)
Confirmation of Benefits and Eligibility information to members and providers.
Identify medical services that require an authorization from the Corporate Client and take appropriate actions (initiate authorization, provide status on existing ones and escalat(?) any issues to Case Management)
Coordination of medical services in/outside the USA, this, in most cases, include locating and contacting several Providers who have the availability and suit the Members preferences and accept our Guarantee of Payment for a cashless experience
Ensure that Providers send claims to the proper address for processing and/or payment and that o...