Medical Claims Manager at LEAD Enterprise Support Company Limited

Responsibilities:

• Design and implement various policies and procedures for claims.
• Provide services to all business requirements and ensure optimal handling of all claims and investigate all issues and provide training for all business units.
• Evaluate all new claims and administer all data integrity data and manage communication to safety department and monitor all claims and ensure timely closure.
• Evaluate all business units’ associate claims.
• Provide training to juniors to manage all outstanding claims and design an efficient duty program and coordinate with HR team to facilitate same.
• Perform regular quarterly audits on all local TPA offices.
• Monitor effectiveness of all programs and provide support to all open claim file reviews and manage all payment cycle to ensure compliance to all contract requirements.
• Design and maintain panel of investigators to use all TPA and prepare reports for monthly chargeback for all business units.
• Analyze all claims to ensure optimal quality and prepare reports for various business units and monitor all chargeback expenses and provide report to all clients and management.
• Perform investigation on all reserve increases and perform regular surveillance of all claim issues and maintain efficient location code listing for TPAs.
• Schedule all internal and external audits on all claims issues and supervise processing of all billing issues.
• Oversee all electronic claims processes and evaluate all self-insurance applications and prepare claims reports and evaluate all actuarial.
• Analyze all claims and identify all risks and ensure processing of all claims as per company policy.
• Forecast all staffing requirements and identify and resolve all issues effectively.

Requirements:

• MSc in Medical field.
• Minimum of 5 years’ experience in HMO and/or health related organization.