Medical Authorization Executive
Medical Authorization Executive FEB 2012 – DEC 2014
• Verifies the enrolment status of claimant, at the same time, inspecting all claim documents.
• Implements fixed policies prearranged by the insurance companies catering to members individually and by group.
• Required to give pre-authorization approvals to hospital providers who need any medical services, such as: IN-PATIENT / OUT-PATIENT / OPTICAL / DENTAL / PHARMACY, for eligible members of a specific insurance company.
• Coordinates with medical provider for verification of documents and wherever additional information is required to assess medical requests properly before giving out any approvals for any procedure or prescription.
• Confer and relay with members any updates / revisions made by their respective insurance companies.
• Effectively assessed and processed claims/ e-claims medically, correlating diagnosis with procedures, tests and prescribed medicines as per Table of Benefits per Insurer.
• Attends claims queries, by updating the insured person/ broker regarding the status of the medical claims submitted
• Easily adapts to change and requires less supervision especially when proper training has been given.