MEDICAL OFFICER in United States

at a Confidential Company

Healthcare / Medical
Banking / Finance / Insurance
Minimum Qualification
Required Experience
1 - 3 years
Employment Type
Full Time
Male or Female

Job Description

Main Duties and Responsibilities:

• Obtain list of covered members
• Register Client on current system
• Prepare and dispatch Invoice to client
• Prepare bill with client
• Prepare Know your client form(KYC)
• Have client complete group proposal form where applicable and obtain policy document
• Organize Service Presentation/health talks
• Request terms
• Obtain renewal terms, claims experience, negotiate terms, prepare renewal report & dispatch to client
• Send out renewal invitation and invoice to individual members
• No individual member should be renewed without payment
• Set up renewal meeting (involve medical mgr)
• Obtain renewal instructions from client and list from client in writing
• Reconcile and renew list on system
• Forward renewal list and new terms to underwriter
• Raise Debits and dispatch to client and underwriter and file
• Obtain premium from client (keep copy of cheque in the file)
• Update Know Your Client form (KYC)and obtain endorsements for changes in policy terms where appropriate
• Filing
Client Liaison
• Acknowledge receipt of query
• Respond to client's query/ requests (where query takes longer than 2 days advise and keep updating client until query is resolved)
• Update underwriters & membership of additions/ deletions
• Hold review meetings with clients (with review reports)
• Visit clients in hospital
• Organize service presentations
• Organize health talks
• Prepare benefit write ups for clients
• Filing
• To monitor all incoming claims and to ensure that they have a received stamp with the correct dates.
• To check claims supporting documents and to contact clients in case of missing documents to ensure complete documentation for onward submission to the Insurers.
• To photocopy all claims documentation for file records
• To check the completeness and accuracy of the claim forms and to assist clients as necessary
• To prepare dispatch letters for claims and to dispatch to the respective insurance companies.
• To maintain an up to date claims database for all clients reflecting all claims received, reimbursements made and indicating the dates the cheques are received.
• Following up with insurance companies to ensure that all claims are paid on time.
Key Result Areas / Accountabilities
• Clear understanding and adherence to Commissioner of Insurance regulations and guidelines.
• Accurate and up to date records of the business written
• Effective liaison with the appropriate staff in the Accounting Department to ensure collection of all monies due to the Company.
• Efficient and effective service to customers.
• Accurate and up to date underwriting and claims records and statistics.
• Up to date knowledge of new products / providers in the market
Knowledge and Skills

a) Education qualifications required
• Minimum of 3 papers , Diploma in Insurance with preference to medical underwriting
b) Work experience required
• Minimum of 2 years in the insurance industry in medical insurance administration
• Working knowledge of Microsoft Office
• Good working Knowledge with multi-user / network computerized systems.
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