As Case Management (CMT) each day you'll be..
- Administrative & Eligibility Verification.
- Review diagnoses and medical procedures based on supporting documents (Eligibility Letter, medical resume, lab results, etc.).
- Ensure treatment are aligned with medical indications and underwriting rules.
- Provide approval to TPA in accordance with limits and policy terms.
- Communicate directly with TPA and providers (hospitals/clinics) (if needed) and regarding guarantee detail.
- Ensure the guarantee SLA is met (fast, accurate, and within target response times).
Requirements:
- Associate Degree or Bachelor degree in health/nursing/or related.
- Have 3-5 years of similar experience as CMT in TPA or insurance industry.
- Excellent communication and interpersonal skills.
- Problem-solving and decision-making skills.
- Attention to detail.