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Claims Quality Control Manager

1.00 to 10.00 Years   Lebanon   30 Jul, 2022
GlobeMed Ltd
1 Jobs Openings
Job LocationLebanon
EducationNot Mentioned
SalaryNot Mentioned
IndustryOther Business Support Services
Functional AreaNot Mentioned

Job Description

GlobeMed Group, the largest Healthcare Benefits Management company in the MENA region is looking for a Claims Quality Control Manager to develop, implement, maintain and monitor a company-wide quality assurance program across all GlobeMed TPA Operations. On other instances, He/She has a key role in testing, designing and updating Fraud, Qaste, and Abuse scenarios following the Guidelines and Rules? department?s strive to automation into existing and/or under development digital technologies and applications.QualificationsQualifications:

  • Bachelor?s Degree preferably in Medicine, Healthcare, Nursing, or a related field or equivalent experience preferred.
  • 5+ years of Experience in professional liability, legal implications, fraud, insurance contracts, Health Claims Management, medical processes and ICT tools.
  • Health Insurance claims experience including claims adjusting, claims auditing and/or claims supervision.
  • Substantial knowledge of health care fraud and abuse laws and regulations.
  • Demonstrated understanding of common fraud schemes and ability to review and evaluate assigned referrals and apply appropriate investigative strategies as needed.
  • Strong knowledge of standard industry coding guidelines such as CPT, HCPCS, ICD 10 and NCCI.
  • Ability to independently develop and present verbal and written investigative and management reports.
  • Demonstrated business acumen, including the ability to see the big picture as well as the relationship of very detailed and specific business issues.

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