As TPA and Provider Management each day, you'll be…
- Case management of complex high value cases.
- Recommendation on claim decision.
- Medical claim analysis for Statistical report purpose.
- Aggressive cost containment through tight adjudication.
- Partner with hospitals and clinics, negotiate tariffs/discounts, and handle contract renewals.
- Monitor external TPAs to ensure they process approvals and claims quickly and follow company rules.
- Resolve billing disputes and issues between hospitals, TPAs, and the insurance company.
- Review medical billing trends to help minimize unnecessary claim costs.
Requirements:
- Doctor (General Practitioner), with 24 hours on call availability.
- Have experience in Insurance, or Assistance Company related industry with minimum 2 years.
- Computer skill: excel, Power point, Word.
- Well organized, able to work independently, able to manage team.