Provision of technical and managerial support for the medical approval doctors.
Supporting the medical approving doctors with answering inbound calls, when necessary, as well as assisting other parties who have specific inquiries.
Supporting the medical approving doctors with queries which may range between coverage questions, network location and medical questions.
Supporting the medical approving doctors in receiving, evaluating and assessing approval requests from Healthcare providers (Hospitals, Laboratories, pharmacies…)
Guide the medical referring doctor to ensure that all needed required documentation (referral form, completed medical reports, related investigation results) are in order.
Review all referred cases to determine completeness of documentation, accuracy of the differential diagnosis and take most appropriate and timely recommendation and action.
Participate in committees, work groups, and/or process improvement teams that improve patient satisfaction.
Being the focal point for the Claims team.
Issuance of necessary medicines and medical approvals - surgeries - X-rays - tests that require it
Medical solving customer problems.
For all non-urgent cases review the need for referral and admission if requested
Be the lead and responsible key person to communicate and negotiate with the external hospital, medical facility or treating doctor
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