Resubmission Supervisor-Kuwait

By New Mowasat Hospital, Kuwait                          Qualification:

Bachelor’s degree in finance or a related discipline. (Nursing, pharmacy, any paramedical

Experience:

• Preferably 7 years’ experience in the field of insurance in Healthcare minimum 3years experience.

DUTIES & RESPONSIBILITIES:

• Liaises with treating physicians to receive properly completed justification of received rejections claim form requests for services which require approvals as per policy terms and conditions.
• Process the claims within a reasonable time frame within SLA and meeting the set KPIs.
• Handle relationships with clients and brokers regarding reimbursement claims by asking for additional information whenever required, by explaining the details of the settlements (i.e. application of the deductible and coverage, justify rejections and uncovered expense.
• Expedites the submission of Insurance claims, collection of receivables and resubmission of rejected claims.
• Adjudicate and approve justified claims within the policy limits set and to refer cases to the claims manager for approval where authority limits are exceeded and interpret and process claims using knowledge of ICD codes, billing, benefits, and company policies. Proactively report critical issues to the Claims manager. Prepares periodic medical and financial rejection reports. Strives to reduce the amount of Rejected claims.
• Prepares monthly reports of claims, Audit’s key indicators with amount of claims individually mentioned and Follow up with treating doctors & gets the precise justification to respond back to insurance companies.
• Respond to and liaise as required with insurance companies and network providers in a professional and courteous manner.
• Provides feedback to Manager, Claims Network and Information System departments of findings to improve quality.