Responsible for analyzing, adjudicating, auditing and processing of claims (Members Reimbursement) according to set medical guidelines, policies within the agreed SLAs (Service Level of Agreements). […]
Ensures accurate and timely processing of claims from medical service providers within authority limits. This involves […]
Accurate claims adjudication as per agreed business Standard Operations Procedures within agreed SLAs […]
Review and escalation of medical codes, supporting documents and observations to determine medical appropriations Researches and determines medical related claims […]
Verification...