Key Responsibilities
- Coordinate with TPAs regarding claims processing, approvals, and reimbursements.
- Monitor and track claim status to ensure timely resolution.
- Verify patient/member eligibility and coverage details.
- Maintain accurate records of claims, authorizations, and correspondence.
- Resolve claim discrepancies and follow up on pending cases.
- Liaise with hospitals, insurance companies, TPAs, and internal departments.
- Prepare reports on claim volumes, turnaround times, and outstanding cases.
- Ensure compliance with company policies and regulatory requirements.
- Assist patients, members, or clients with insurance-related inquiries.
- Support audits and documentation reviews as required.