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CLAIMS ASSESSOR

Description

Duties and Accountabilities:

-Claims Creation

1. Accurately performs on system, the daily opening of Medical claims received as per established guidelines.
2. Requests additional information from Policy holders and providers as needed.
3. Fully documents claims for referral to senior staff for review and adjudication.
4. Verify input to ensure completeness and correctness of information.
5. Provide support to the Operations department upon request.

-Assessing of Claims

1. To accurately review and adjudicate medical claims based on policy terms and conditions while respecting procedures (assessment, processing of payments on system):
• To timely request additional information from policy holders and providers (e.g from hospitals, opticians and medical assistance companies) as needed.
• To urgently initiate and complete claim investigations where required, including pre-existing medical conditions, accidents, medical necessity and appropriateness.
• To accurately and fully document claims for referral to senior staff for review and adjudication.
• To reply to clinic within the hour to confirm client is insured ensuring scale of costs is applied for Doctor’s fees.

2. To assist with maintaining the statement of account from providers.
3. To assist providers with claim queries received by post and by phone.
4. Scan all documents for declined cases before submission for approval.

-Other Responsibilities:

1. Adhere to the policies and procedures of Linkham Services Ltd.
2. Maintain strict confidentiality of client, company and personnel information.
3. Demonstrate a strong commitment to the mission and values of Linkham Services Ltd.
4. Adhere to company discipline principles.
5. Perform other duties as assigned or as required from time to time.

FULL TIME JOB- 8:30-17:00 WEEKDAYS

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