JOB PURPOSE The Jobholder serves providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He / She should provide accurate and relevant medical coverage details, maintain pre-approvals and claims processing and adjudication cycle within NHS software systems as per the defined terms and policies of the organization; He/ She will be guided by the regulations laid down by the regulatory authorities such as MOH, DHA or others. 2. RESPONSIBILITIES AND DUTIES • To issue online and verbal authorizations based upon member coverage & medical justification. • To assist queries from providers and payers via phone calls or e-mails. • To maintain files for authorizations and other reports. • Assessing and processing claims in line with the policy coverage and medical necessity. • Be fully versed with medical insurance policies for various groups / beneficiaries. • Might be required to assist in training colleagues and sharing knowledge. • Able to accurately assess eligibility within the UAE (HAAD and DHA) guidelines as well as policy boundaries. • Monitoring and maintaining the claims processing and adjudicating cycle in NHS operational software system as per the defined terms and policy of the organization. • Establishing strategies and implementing effective parameters for solving all possible queries within the team. • Taking a lead role in assuring that the assigned tasks to the team are completed within the allocated time frame. • Ensures the proper communication and implementation of new formats, training and processing rules. • Entering and processing/ adjudicating claims in NHS operational software system as per the terms and policy of the organization. • Taking initiatives to maximize team efficiency. • Maintaining both qualitative and quantitative claims measures. • Ensure adherence to the predefined TATs for claims and pre-approvals. Statements in this Job Description are intended to reflect, in general, the duties and responsibilities of the position, but they are not to be interpreted as totally inclusive. NAS Neuron Heath Services LLC is an equal opportunity employer. Internal Information - Do Not Distribute • Achieving required processing targets assigned by the team leader on daily, weekly and monthly basis. • Monitor the qualitative and quantitative measures for claims & pre-approvals. • Ensure compliance to any changes in terms of system parameters or process. 3. KNOWLEDGE, SKILLS AND EXPERIENCE • University degree in any discipline of Medical/Para-medical specialization from a reputable university. • Healthcare/Hospital experience for 1-2 years, in departments such as Surgery, ICU or GP, is required. • 1 - 2 years of work experience in the Insurance industry is preferable but not mandatory. • Excellent oral and written communication skills. • Must be computer literate. • Excellent command of the English language, Arabic is a definite plus. • Should be a team player with an aptitude for customer service. Must be service oriented. • Highly decisive with outstanding logic and reasoning skills. • Candidate must be tactful and discrete while dealing with Providers or Payers; must be able to handle confidential information. • Ability to work under pressure and meet tight deadlines and varying work-schedules. 4. COMMUNICATIONS AND WORKING RELATIONSHIPS The job holder interacts with all Departments within NNHS and other service providers. He/ She must ensure seamless communication between all departments for the smooth operations and to achieve the organizational objective. He/ She must be able to foster strong internal & external communication standards. 5. OPERATING ENVIRONMENT He/she works in an air-conditioned environment and spends most of the day at desk. The Jobholder’s working hours are flexible as per weekly schedule within the boundaries of the UAE labor law. The job holder is not exposed to any obvious hazards. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
