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Senior Claims Officer

10.00 to 12.00 Years   Doha, Qatar   29 Feb, 2024
AL KOOT INSURANCE & REINSURANCE CO.
1 Jobs Openings
Job LocationDoha, Qatar
EducationBachelor's degree / higher diploma
SalaryNot Mentioned
IndustryInsurance & TPA
Functional AreaNot Mentioned

Job Description

Position : Senior Claims OfficerSection : Medical & Life InsuranceCompany : Al Koot Insurance & Reinsurance CompanyLocation : Doha, QatarExperience : 10? 12 Years relevant experienceNo of resources : 1Purpose: To supervise and manage the Claims function, obtaining the required information from the insured members and assessing their eligibility, in order to settle claims in an effective and efficient manner.Job Summary :

  • Evaluate claims of patients against policies and coverage information, and discuss the more complex ones to line manager in order to settle them as per established policies.
  • Ensure that proper and complete instructions on claim eligibility are provided on pre assessment sheet for proper and timely settlement of the claim.
  • Supervise the claims processing and ensure all claims team are following the claims policy and procedure.
  • Conduct regular team training to improve the claims performance.
  • Ensure all records are kept in order as per the department policy and procedure.
  • Conduct periodic internal audit to monitor the quality of the claims processing
  • Monitor the claims TAT and ensure that the claims process are within the agreed TAT
  • Distribution of workload to the team members based on the experience of the team members.
  • Maintenance of Productivity and QC Reports for the team
  • Periodic review and evaluation
  • Annual performance appraisal of the department
  • Adherence to regulatory requirements
  • Interdepartmental Coordination
  • Ensuring error free processing of preauthorisation within agreed TAT (Turnaround time).
  • Ensure high accuracy of all the authorization approval as per the process.
  • Approving high value Pre-Auths and if there are any escalation from the team members.
  • Escalating to the direct line manager for extreme complex cases.
  • Solving customer queries wherever medical opinions are required and need to be address by the medical practitioner
  • Make sure the internal processes and regulatory requirements are met and maintained with fewer complaints by the team

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