Customer Service Advisor-Healthcare

Transguard Group was established in 2001 and has diversified significantly, we lead in the fields of Cash Services, Security Services, Manpower Services, Facilities Management & Aviation. Transguard Group is the UAE’s most trusted business support and outsourcing provider and has a large, dynamic, and culturally diverse workforce with 50,000 employees!  We are currently recruiting for a Customer Service Advisor-Healthcare for our Client which is based in Dubai.

Responsibilities:

• Review all the enrollment/application forms to ensure they are complete
• Enter all data in CIRIS for policy and endorsements issuance
• Issue all the Medical ID Cards for all the Beneficiaries
• Ensure that all Enrollment/Application documentation is filed and stored in the dedicated manual and/or electronic retrieval system
• Analyze prior-approval requests, negotiate the cases with the medical providers, approve the cases when agreement is reached and enter the claim into Ciris.
• Supervise In-patient claims (this supervision includes visits to the patients during their hospitalization)
• Communicate with Insured Members on their claims and on any request coming from an Insured Member
• Receive claims from the reception or via eclaims download
• Sort & register all received claims and ensure claims are properly documented.
• Ensure that all claims documentation is filed and stored in the dedicated manual and/or electronic retrieval system
• Check all payments including cheque/draft values and other supporting enclosures for technical and clerical accuracy
• Register & dispatch all claim payment
• Segregation of direct billing claims
• Scanning of documents
• Filing of claims & sending to infofort for archive

• Clinical or paramedical qualifications/ degree required at Tertiary level
• To possess and demonstrate knowledge of Medical Policy wordings for policies issued.
• The job requires a sound knowledge of all medical insurance policies and billing policies.
• The job requires expert knowledge of medical conditions, treatments and procedures in order to guide claimants and challenge medical practitioners and healthcare providers.
• Computer Skills, Word, Excel and Data entry
• English speaking and writing
• 2 years in clinical/paramedical field and preferably customer contact experience