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Key Responsibilities:
- Manage and oversee high-end medical claims processing, ensuring accuracy and compliance with company policies and regulations.
- Evaluate claims for validity, assessing medical documentation and treatment plans to determine coverage eligibility.
- Liaise with healthcare providers, policyholders, and internal teams to resolve complex claims issues and inquiries.
- Conduct thorough investigations on claims to prevent fraud and ensure adherence to industry standards.
- Provide guidance and training to junior staff members, fostering a collaborative and knowledgeable team environment.
- Stay updated on medical advancements, policy changes, and regulatory requirements impacting high-end medical claims.
- Bachelor’s degree in a relevant field (e.g., healthcare administration, insurance, business).
- Minimum of 3 years of experience in medical claims processing, preferably in a senior capacity.
- Strong understanding of medical terminology, insurance policies, and claims regulations.
- Excellent analytical and problem-solving skills, with a keen attention to detail.
- Exceptional communication and interpersonal skills, capable of building relationships with various stakeholders.
- Proficient in claims management software and MS Office applications.
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