Key responsibilities/What you do:
- Evaluate and approve medical requests in line with policy guidelines.
- Verify the necessity of treatment plans for patients.
- Regularly enter verbal and written claims approvals.
- Make approval decisions based on policy terms.
- Review and decide on high-cost and complex claims.
- Provide clear, detailed feedback to the Call Centre team’s inquiries.
- Explain reasons for declined medical claims to clients.
- Manage workflow efficiently to meet deadlines.
- Assess claims for eligibility criteria