Lowongan DOKTER CLAIM KESEHATAN di PT Vads Indonesia

Required Work Experience :

• Fresh graduates are welcome, or 1 year working experiences

Required Skills and Knowledge :

• Knowledge in Insurance Verification
• Expertise in Clinical Classification or ICD
• Have a good healthcare management.
• Having knowledge in Insurance especially Health
• Good communication both verbal and written for internal and external business communication
• Computer competency (Outlook, Excel, Word and Company Software)
• Medical Doctor degree certificate

Key Responsibilities :

• To attend transmission and to attend Case Quality Review in Operation Excellence every working day and duty day and to give case direction to the best of his/her knowledge
• To assist daily activity in Operation Excellence Department in obtaining sufficient medical reports from the medical providers to move the case forward.
• To assist daily activity in Operation Excellence Department to ensure reviewing medical reports from the medical providers are done in timely manner to full fill the Turn Around Time (TAT)
• To assist daily activity in Operation Excellence Department in providing recommended medical providers for the clients.
• To assist daily activity in Operation Excellence Department to negotiate with the medical provider for the best pricing, corporate price, or discount and to review the hospital billings whenever is required
• To manage and supervise Medical Claim Excellence staff in managing the case properly and in the line with the standard operations policy and procedure.
• To have a good relationship with the medical providers and to ensure that the medical providers will provide the best quality of healthcare rendered by our clients.
• To conduct billing audits of all received invoices prior to any payment done in order to get the best review of medical claims.
• To ensure all information related with the case activities are well documented in the system.
• To ensure that all close case/claims have the ICD-9 been verified in the system.
• To handle any complaints raised by clients or service provider towards Operation Excellence Department.
• To Escalate to Medical Claim Excellences Assistant Manager if the complaint is serious and need further follow up to mitigate service recovery.