Job Description

About the job

MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Claims Team Leader who will manage and direct the Claims Team in order to assure that all incoming medical claims were processed efficiently and accurately according to scope of coverage and provider contracts. Assuring effectiveness of workflow in the Claims department along with work distribution to the team.

Your Job:

• Maintain quality of processed claims through managing claims team in applying policies & procedures along with quality measures that are set for the Claims Department.
• Distributing and organizing work load for Claims Team.
• Conduct random check and audit for processed claims from medical perspective and compare according to scope of coverage, provider contracts, etc.. as per Policies and Procedures of claims department.
• Develop and maintain claims process in regard to validity and quality of the entered data into MN+ System in order to provide accurate records to the company.
• Ensure that set TAT is met through organizing and distributing claims to be processed by the claims team.
• Provide medical guidance to the Claims team and assist in ICD coding in coordination with MNU inhouse team.
• Manage the effective achievement of objectives through setting individual objectives, managing performance, developing staff and providing formal and informal feedback in order to maximize overall performance and team motivation.
• Coach and provide on the job training and support to individuals falling short of targets in order to ensure maintenance of defined processing targets.
• Handle changes in the workload flow in terms of time, quantity and type of requests received with a clear focus on the both quality and set target.

Your Profile

• Bachelor’s degree of Medicine or Pharmacy
• 4-5 years of experience in their educational field.
• Previous experience in the insurance field is a must.
• Fluent English language
• Excellent verbal and written communication skills
• Time management skills
• Strong leadership, planning and organizational skills
• Attention to details.
• Ability to operate effectively with people at all levels of the business.

Requirements added by the job poster

• 1+ years of work experience with Policies & Procedures