Deputy Manager

KEY ACCOUNTABILITIES: 

• Assist in the management of provider relations efficiently with skilful negotiation of prices and ensuring provider KPIs support profitable development and growth of the business and the achievement of overall departmental objectives
• Develop monthly statistical reports to facilitate benchmarking and performance review of network operations & utilization trends for management decision-making in local & regional offices
• Appropriate and timely intervention to resolve issues of providers related, amongst others bills or claims settlement
• Perform audit of (randomly) selected claims to ensure quality processing
• Ensure signoff letters are obtained from all providers after reconciling books of accounts of both parties
• Update data relating to addresses, discounts, tariffs, service charges, creation of new codes, specialties on need basis
• Deal with case management, approval, pre authorization & rejections & processing them in company’s database ensuring all information that is supplied is eligible for payments to be made
• Telephonic investigation / verification of facts involved in the claims & pre-authorization
• Take statements & consult with claimants, doctors & relevant individuals to examine records and forward to the Manager, if required to determine potential frauds in claims processing & investigate the procedures
• Provide clarifications regarding policy wordings to insured & other stake holders
• Maintain client’s pre-employment/periodic medical records, inform related parties for fitness/re-assessment (if any) & prepare reports for settlement of their bills that falls within & beyond scope of policy

SKILL SET:

• Must be a licensed Doctor
• Have 3-4 years of relevant experience