JOB DETAILS:
Job Description
To manage medical benefit utilization through supervision of pre-authorization answer queries over the phone and give timely solutions to the customer.
• Pre-Authorization of all admissions within 6 hours and technical guidelines.
• Minimize identifiable cases of fraud/abuse
• To resolve customer queries over the phone and offer solutions to the customers in a timely manner
• Supervise Pre-authorization of scheduled and non-scheduled admissions within the set guidelines and carry out verification and medical Audit of claims/invoices before settlement.
• Managing requests for services from providers, intermediaries and clients, providing information on the UAP Old Mutual provider network and available benefits per scheme policy
• In conjunction with SMART applications resolve card issues raised at the point of service
• Authorization of all optical requests from the different providers within 6 hours and prepare daily reports
• To attend to reimbursements from the…
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