Brief Summary
Join a dynamic organization in a pivotal role focused on managing and overseeing high-value claims. Leverage your expertise in medical claims adjudication while supporting operational processes and product development in a global context. Responsibilities
Provide medical guidance and manage Controlled Claims in compliance with contractual arrangements, ensuring accurate reporting to stakeholders. Conduct Claims Audits according to the Annual Audit Schedule and deliver comprehensive reports aligned with company standards. Collaborate on policy wording and claim processes, offering training to partners and stakeholders. Identify and address potential fraudulent claims, ensuring proper rectification procedures are followed. Deliver ongoing training and best practice guidelines on claims processing to internal and external stakeholders. Prepare monthly management reports to track claims and operational metrics. Be on standby to manage urgent claims approvals during afte...