Handle insurance recoupment and reconciliation works, communicate with providers and members via call and email for collection and explanation
Follow up on manual claim and SOP strictly, adjudicate claims according to benefit policies, and meet both financial/procedure accuracy and target on claims adjudication
Performed insurance claims assessment according to the actual situation
Review the approved claims to ensure the accuracy and made an adjustment as necessary
Generate daily claim process and all related document from the system and preparing claims documents to be sent to the payer
Investigate claims through liaison parties to determine the eligibility of the claims
Complete all daily call log and daily claim log
Prepare claim report on a regular basis
Accountable on daily operations to meet productivity or service standards as defined by management in line with department and/or division