Description

• Manage, evaluate and adjust Accident & Health claims as per the policy terms and conditions including application of exclusions if applicable.
• Work and manage as many fast track claims as possible (Medical Expenses) and analyze medical records.
• Assist in resolving complaints from policyholders relative to claims.
• Comply with OCS, PMP objectives, Claims Best Practices guidelines & standards of services as required.
• Do coverage determination position letters to policyholders.
• Perform specials projects and other related duties as assigned.
• Make timely decisions on claim approval, partial payment, or denial with clear justifications.
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  Identify potential fraudulent claims and refer cases as necessary for investigation.