Care Analyst
Job Summary
The role holder will be responsible for ensuring that Heritage customers receive affordable, accessible, cost effective and high-quality healthcare services.
Key Responsibilities
- Membership benefit utilization management
- Verification and assessment of pre-authorization requests and claims
- Hospitalizations management and cost optimization
- Review and pre-screening of received claims
- Customer service-handling calls, addressing client queries on all touch points
- Maintain proper departmental standards
- Process/adjudicate claims
- Case management through hospital visits
Qualifications
- Bachelor’s degree in Nursing/Diploma in Nursing or Clinical Medicine
Experience
- At least 1 year technical knowledge in medical insurance or hospital setting.
Competencies
- Understanding of health insurance operations and concepts
- Knowledge of medical claims processes and procedures
- Stakeholder management
- Customer service