healthcare case mangment officer

General Description:
Manages medical aspects of claims for Third Party Administration (TPA) accounts by coordinating with patients, physicians, other health care providers and employers to facilitate positive patient outcomes, timely return to work if applicable and efficient claims resolution.
Responsibilities
Manages activities of workers claims, case management and utilization review according to established policies and procedures and applicable legal and regulatory guidelines.
Manages ongoing managed care activities, including case management of medical aspects claims for TPA accounts by coordinating with patients, physicians, other health care providers and employers to facilitate positive patient outcomes, timely return to work if applicable and efficient claims resolution and utilization review, gathering demographic and clinical information on inpatient admissions and outpatient treatment, certifying the medical necessity of the services and assigning appropriate length of stay and other treatment plans.
Presents case management and utilization review information and overviews to prospects and clients as needed.
Assists adjuster with complex medical aspects as necessary. Resolves escalated issues and problems by conferring with staff, management, other internal departments, outside contacts and clients as necessary. Performs case management and other activities as workload requires. Responds to requests from insurance carriers, medical personnel, attorneys and others.
Assesses internal and external customer needs and manages activities to ensure services are delivered in the most efficient way possible.
Reviews and evaluates medical claim activities on a regular basis, ensuring that established policies and procedures are being followed.
Ensure ongoing department communications with sales, claims and management as well as other Company departments to exchange account and other information.
Maintains knowledge of current developments in the managed care industry, including regulatory issues and guidelines changes.
Participates in special projects and performs additional duties as required.
Contributes to a positive, ethical and respectful working environment and communicates openly with others. Models Company culture both internally and externally.
Responsibilities
Manages activities of workers claims, case management and utilization review according to established policies and procedures and applicable legal and regulatory guidelines.
Manages ongoing managed care activities, including case management of medical aspects claims for TPA accounts by coordinating with patients, physicians, other health care providers and employers to facilitate positive patient outcomes, timely return to work if applicable and efficient claims resolution and utilization review, gathering demographic and clinical information on inpatient admissions and outpatient treatment, certifying the medical necessity of the services and assigning appropriate length of stay and other treatment plans.
Presents case management and utilization review information and overviews to prospects and clients as needed.
Assists adjuster with complex medical aspects as necessary. Resolves escalated issues and problems by conferring with staff, management, other internal departments, outside contacts and clients as necessary. Performs case management and other activities as workload requires. Responds to requests from insurance carriers, medical personnel, attorneys and others.
Assesses internal and external customer needs and manages activities to ensure services are delivered in the most efficient way possible.
Reviews and evaluates medical claim activities on a regular basis, ensuring that established policies and procedures are being followed.
Ensure ongoing department communications with sales, claims and management as well as other Company departments to exchange account and other information.
Maintains knowledge of current developments in the managed care industry, including regulatory issues and guidelines changes.
Participates in special projects and performs additional duties as required.
Contributes to a positive, ethical and respectful working environment and communicates openly with others. Models Company culture both internally and externally.
General Description:
Manages medical aspects claims for Third Party Administration (TPA) accounts by coordinating with patients, physicians, other health care providers and employers to facilitate positive patient outcomes, timely return to work if applicable and efficient claims resolution.

Job Details

Date Posted: 2017-09-26
Job Location: Riyadh, Saudi Arabia
Job Role: Medical, Healthcare, and Nursing
Company Industry: Insurance
Monthly Salary: US $3,000

Preferred Candidate

Career Level: Entry Level
Nationality: Saudi Arabia
Degree: Bachelor's degree

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