Outpatient (OP) Medical Board Executive

Running our operations in a responsible, sustainable way.

Job purpose:

To assess and evaluate the preapproval requests received by the providers in terms of medical eligibility and policy terms and meeting the client expectations appropriately and providing a World Class Customer Service experience throughout the process.

Key Responsibilities:

• Adjudicating and Processing insurance pre-approvals in a timely and accurate manner following Company policy terms and conditions, process Guidelines. Process pre-approvals within the agreed TAT per line of business.
• Providing preapproval for medical claims based on medical eligibility and policy terms.
• Contribution in cost containment through GIG Guidelines and proper medical adjudication.
• Contribution in Fraud Waste and Abuse management in the pre-approval function.
• Assist team leaders in Queue management, Customer care email management as required on adhoc basis.