Senior Medical Claims Officer (SRF # 407)

4.00 to 0.00 Years Amman, Jordan 23 Dec, 2020

Job Location	Amman, Jordan
Education	Bachelor's degree / higher diploma
Salary	Not Mentioned
Industry	Non-profit Organization
Functional Area	Not Mentioned

ESSENTIAL DUTIES AND RESPONSIBILITIES

Registration of claims upon receive.
Make sure that all claims documents and details are complete (original invoices, medical reports, diagnostic procedure results, copy of referral)
Medical examination to ensure that the treatments and procedures match the diagnosis.
Examine whether the incurred treatments and procedures are covered under the referral letter conditions,
Assure that treatments and procedures didn?t exceed the referral estimated cost.
Entering all claims details into system.
Compare the approval given with actual claim.
Applying the agreed price list, package deal and discounts for each provider.
Monthly Reconciliations with all medical providers.
Prepare monthly detailed reports for each medical provider
convert entered and audited claims to financial department and coordinate with finance for payments.
prepare the required statistical reports
Manage and supervise the claims officer and work flow.
Make sure that all received claims been processed and allocated to system on time without delay
Double Check the processed claims to make sure that all examination process goes in order
Follow the financial and payment process to hospitals, and make sure that all payments done on time.
Correspondence with all medical Providers and solve any conflict or outstanding issues with them.
Coordinate with finance officer referral in administrative issues and payment process

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