About the Company
We are an international organization operating in the insurance and employee benefits sector, delivering health insurance and customer care solutions for employees, international companies, institutions, and NGOs worldwide.
Our teams work in a multicultural and fast-paced environment, where service excellence, empathy, and reliability are key to supporting members across borders.
DUTIES AND RESPONSIBILITIES
Main Responsibility:
- Gives advice on medical requests from all departments and clients.
General Responsibilities:
- Review pre-authorization and referral requests for medical appropriateness.
- Handle medical queries from members and client companies.
- Provide medical opinion to other departments.
- Update risk carriers on high dollar cases
- Advise PRECERT team on complicated pre-authorization cases.
- Organize medical training sessions.
- Review and sign off claims above 10,000.
- Foster relationship with worldwide medical team
-Medical Case management of identified complexe cases.
Performance Measure:
- Ensure quality customer service.
- Follow-up actions to increase productivity.
- Encourage continual improvement.
- Represent and promote Medical team.
- Ensure professional company reputation.
Experience:
- 2-3 years clinical activity or TPA & Insurance experience.
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