Medical Claim Manager

Job Summary:
The Medical Claims Manager will be responsible for overseeing the management and processing of medical claims for one of our clients, an insurance company. Ensuring timely, accurate, and efficient claim resolutions. This role involves providing guidance and support to clients regarding the claims process, handling complex and disputed claims, and collaborating with various departments to resolve claims issues effectively.

Key Responsibilities:

• Gather and verify all necessary information and documents for claim submissions to ensure proper processing.
• Review and assess medical reimbursement claim to ensure all documentation is complete and accurate, and manage the claims process in line with established timelines.
• Advise clients on the medical claims process, including eligibility, documentation requirements, and timelines. 
• Collaborate with relevant stakeholders to resolve complex, disputed, or suspicious claims through effective communication and investigation.
• Work closely with the reinsurance department to assess the coverage for non-standard surgeries or medical procedures included in reimbursement claims.
• Develop and execute investigation strategies for claims in contested or suspicious situations to ensure thorough review and resolution.
• Oversee and manage international medical claims in alignment with global benchmark standards and fee structures.
• Analyze and summarize the terms of insurance policies to facilitate accurate claims processing and ensure adherence to the terms.
• Implement cost-control measures, ensuring compliance with tariff guidelines and established benchmarks to minimize unnecessary expenditures.
• Manage, mentor, and lead a team of medical claims specialists, providing guidance, training, and support to ensure optimal team performance and adherence to company policies.

Qualifications:

• Bachelor's degree in Medical or a Doctor's degree.
• Minimum of 5 years of experience in medical claims management or a related role.
• Strong knowledge of medical reimbursement processes and insurance policies.
• Excellent analytical, problem-solving, and communication skills.
• Ability to manage complex claims and collaborate effectively with multiple departments.