Senior Authorization Executive
Neuron LLC
Total years of experience :4 years, 0 Months
June 2010 to June 2013 Neuron LLC
Senior Authorization Executive
Duties and Responsibilities: * Handle all inbound and outbound calls efficiently and competently.
* Provide the critical link between the insurer and member. In order to gain strategic advantages from higher customer satisfaction.
* Possess good communication skills which are necessary to converse with providers, members and insurance companies.
* Evaluate the claim if appropriate for approval in accordance with the policy and benefits of the member.
* Obtain information from providers for purpose of authorization.
* Assess the medical condition of the member in order to issue a request
approval or denial as per the policy.
* Review online system instructions and its updates to decide appropriate
course of action with each claim.
* Ensure every claim requests are processed in accordance with all
internal instructions and guidelines.
* Route complex claims to the appropriate area for additional
processing.
* Review and evaluate medical justification for the approval of payment.
* Update claims processing system as needed.
* Responsible for processing of medical claims.
* Analyze and manage the insurance claim and checking it for validity.
* Review and assess the claim, submit payment to the provider if a claim
is covered by the member's insurance policy.
* Validate the information on all the medical claims received. Thoroughly
review and ensure that there is no missing or incomplete information.
* Know how to correctly read and assess medical documents.
March 2009 - January 2010 One Tagaytay Place Suites (Philippines)
Hotel Nurse
Duties and Responsibilities: * Provide health needs of the guests and hotel staff.
* Undertake emergency treatment and first aid to patients.
* Attend to bring the patient to the nearest hospital.
* Regularly refill the first aid kits with emergency medicines at designated
areas of the facility.
* Process of health insurance cards and payments.
* Recommend and sign the sick leave application of the hotel staff.
* Prepare and encode letters, correspondences and documents.