AVP, Pre-Claims Authorization Assessment
2 weeks ago
About the Job
To ensure accurate and timely assessment of pre-claims authorization requests. The role is focused on giving customers assurance before their admissions by delivering precise evaluations, clear communication and assurance of coverage. This includes managing pre-claim investigations, liaising with medical professionals, and resolving escalated cases promptly to meet or exceed service standards.
• Provide accurate and timely assessment of pre-claims authorization requests within service standards.
• Manage and review specialized pre-claim investigations and appeals with fairness and precision.
• Liaise with medical professionals, hospitals and policyholders to clarify requirements for pre-claim authorization approvals.
• Deliver excellent service by providing assurance to customers and exceeding expectations in pre-claims authorization.
• Proactively identify and recommend alternative solutions to give customers confidence before admissons.
• Oversee escalated cases to ensure prompt resolution in line with service quality commitments.
• Take accountability for business and regulatory compliance, mitigating risks effectively.
• Stay updated on regulatory changes and industry development to anticipate and manage emerging risks.
• Undertake any other ad-hoc projects as assigned.
We are looking for people who
• Bachelor's degree in business, healthcare administration, or related discipline.
• 5–8 years of experience in customer service operations, preferably in insurance claims.
• Strong problem-solving, communication, and stakeholder management skills.
• Familiar with letter of guarantee issuance workflows and healthcare provider interactions.
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