Customer Service Manager
2 weeks ago
for Health Reimbursement Claims Processing doctor.
- Medical Evaluation and Documentation
- Examine claim documents and understand detailed clinical findings.
- Document diagnoses, treatment plans, and procedures done clearly.
- Ensure medical records are accurate and complete for claim submission.
- Certification and Verification
- Certify the necessity of treatments or procedures for insurance claims.
- Verify the authenticity of medical reports submitted for claims.
- Provide second opinions or independent medical examinations (IME) when required.
- Compliance and Ethical Oversight
- Ensure all documentation and certifications comply with regulatory and insurer policies.
- Prevent and report fraudulent claims or misrepresentations.
- Advisory Role
- Advise insurance companies on complex medical cases or disputed claims.
- Participate in claim review committees or panels if needed.
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