**JOB PURPOSE**

The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per terms of benefits. He/She should provide accurate and relevant medical coverage details and maintain pre-approvals and claims processing as per the defined terms and policies of the organization.

**RESPONSIBILITIES AND DUTIES**

+ Processes claims from members and providers.
+ Assists queries from providers and payers via phone calls or e-mails.
+ Maintains files for authorizations and other reports.
+ Assesses and processes claims in line with the policy coverage and medical necessity.
+ Be fully versed with medical insurance policies for various groups / beneficiaries.
+ May assist in training colleagues and asked to share knowledge.
+ Accurately assesses eligibility within the policy boundarie...