WARBA Insurance - Kuwait City - Role Title: Claims Process Executive Role purpose summary: Pre-approval and Claims processing Key Responsibilities and Accountabilities: Data Entry in the system Responsible for screening all the Preapprovals including in-patient cases. Take decisions based on policy wordings, coverage, limits, necessity and correctness of the service codes. Medical reports analysis and assessment. Providing a medico-legal justification elements for the rejected or partially approved cases. Handling the calls of the Preapprovals and medical queries. Capturing the details of the invoice (Member Name, Policy Number, Group Name, Received Date, Lot Number, Invoices) into the system. Auditing the system adjudication with the benefits and the amounts claimed Comparison with Provider Statement (For Direct Billing Claims). Updating the Team Leader with the progress report. Achieve the targets put up by the Team leader Skills Person Profile (K.S.A.O): Min. 1...
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