Designation : Consultant Medical Rejections
Reporting to : CFO, and would be working in collaboration with the
Insurance Unit In-Charge
Team : None
Interaction : Insurance companies, Medical Admin, Doctors, Insurance unit,
Accounts & CSD
Job Description : Support the process, in collaboration with the Insurance
Unit in-charge, of systematically investigating each denials, performing root
cause analysis of why each claim was denied, analyzing denial trends to
uncover a trend across insurance companies and re-engineering the process to
reduce future rejections. Key activities involve:
* Joint responsibility for reducing the medical rejection rates: Investigate the reason for every denied claim, focus on resolving the issue, resubmitting the request to the insurance company and filing appeals where required and liaising with the doctors on fixing the claims;
* Supporting CFO with the needed inputs for final settlements and reconciliation of the rejected claims;
* Guiding and supporting medical claim officers and ensuring timely re-submission of claims to the insurance company as per assigned schedule and target dates;
* Liaising the quarterly and annual audit reviews from the insurance companies and resolving for any possible financial implications;
* Reviewing pre-approval rejection trends and identifying areas of improvement to minimize opportunity loss.
* Organizing and supporting departmental meetings, trainings and educational programs;
* Process and workflow automation. Reduce efforts to check the claims' status by improving the adoption of web portals to obtain claim status online. Defining claims follow-up work queues with web-based workflow systems that improve the documentation quality;
* Keep self and the function abreast with the best practices, market intelligence and latest developments on controlling rejection management.
Immediate tasks: Would be to review overall rejection management process
with special focus on medical rejections, assess key interaction points and
activities, deep dive into our current medical rejection trends, and identify
areas of improvement and upcoming challenges given the evolving ways of
working of the insurance companies.
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