About the Role
Precertification Officer
Precertification officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards.
Key responsibilities/What you do:
- Assesses approval of medical approvals as well as policy use.
- Checks particular treatment plan is necessary for the patient.
- Inputs verbal and written claims approvals regularly.
- Decides approvals as per policy conditions.
- Assess high cost claims and provide decision on high cost and complicated cases.
- Provides clear feedback on queries from call Centre team.
- Provides clients an understanding of any declined medical claims.
- Coordinates work flow & meet deadlines.
- Evaluates claims with regards to eligibility.
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