Medical Board Consultant / Medical Approval Officer
Axa Life Insurance
Dubai
Job Purpose:
To scrutinize in a professional manner medical claims (both reimbursement and direct billing) and to provide prior approval for medical treatment. In carrying out this role the jobholder will liaise and negotiate with the medical providers to ensure the validity of the treatment as per the insurance policy terms and conditions and to ensure that prices are in line with those agreed for Network providers or remain reasonable and customary for non Network providers. The role is responsible for effective communication with the Insured Members in order to explain the covers and answer any specific question related to a given claim.
Main Accountability:
- Handle relations with the Medical Providers which includes negotiating all the discounts, studying all the price lists, handling reconciliations and visit the Medical Providers on a regular basis;
- Analyse prior-approval requests, negotiate the cases with the medial providers, approve the cases when agreement is reached and enter the claim into AXA Insurance E.C. IT system;
- Supervise In-patient claims (this supervision includes visits to the patients during their hospitalization);
- Advise on Medical Basics and Practice;
- Assist Medical Claims Administrators in processing claims;
- Validate all medical claims in AXA Insurance E.C. s IT system;
- Communicate with Insured Members on their claims and on any request coming from an Insured Member
- Drive training and information seminars on AXA Insurance E.C. medical products directed toward clients, prospects and internal Sales forces.
- Ensure that all medical information is kept confidential
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