Role Summary:
Part of Insurance Relations Management department, ensuring all resubmission prepared and submitted as per TAT of regulator and claims analyzed to optimize resubmission rejection as per agreed KPIs. Accurate and in-depth analysis of rejection for effective resubmission process thereby ensuring maximum revenue, identify discrepancies and resolve the denied claims reaching the optimal target levels.

The main responsibility of the role is to resubmit claims with highest quality and to ensure the claims are paid. This requires attention to details as the claims are already rejected previously at submission and is now in the resubmission process for settlement.

Key Responsibilities:
• Evaluates and ensures that all the medical & technical claims denied or underpaid inappropriately by payers are identified, appealed and reversed as per the set deadlines.
• Maintains production goals and quality standards set by the department.
• Ensures all claims are resubmitted in compliance with coding, insurance and regulator guideline
• Maintains and achieves the set TAT’s.
• Provides daily feedback to Team leads on rejection trends, and to avoid it in the future in order to optimize clients’ revenue, conveys such feedback to team leaders for future occurrence
• Raises queries to the team leader to get required documents or escalation of concerns.
• Analyze denials and perform claim justification for resubmissions as well as provide feedback and recommendations for corrective measures at claim submissions level.
• To undertake any additional tasks assigned by the line manager in accordance with operational requirements.