Job Description
Verify and analyze all data on claims/cases and ensure these meet the project objectives as well as payer expectations for the various projects. To send back simple yet detailed feedback to the provider team where claims/cases do not meet the project expectations. To ensure any general trends or inconsistencies noted are reported to the operations and provider teams. Timely assessment of claims and cases submitted by the providers, ensuring the queries raised are understood, and following up with the provider team to ensure they are resolved. Provide support to the customer call center to address medical queries that have been escalated to CarePay. Document and be able to extract, present, or discuss provider practices or disease trends. Deliver feedback and training aimed at addressing the trends picked from the claims/case assessment exercise. Mapping generic rules to medical services, procedures, drugs and lab tests. Participate in testing and documentation of selected CarePay syste...