Gulf Insurance Co. - Kuwait City - ·To contain cost by performing quality assurance assessments of services within a healthcare system involving financial, logistical, patient services and health management systems. ·To investigate, analyze medical files for specific cases when needed with providers. · To uphold the company’s ethics, operating policies and conform with the department work instructions. ·Evaluates the approval request in terms of medical necessity and consistency of diagnosis, procedure and medicine codes with the international medical guidelines / practice. ·Evaluates the approval request in accordance with policy terms and conditions. ·Ensures accurate payments in accordance with the contract, SOA, correct allocation of benefits and adherence to claim submission guidelines. ·Acquires the required technical skills to process claims through the system. ·Achieves daily targets effectively and efficiently. ·Ensures the best quality in claims auditing and escalates the observatio...
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