Process all types of health insurance claims including but not limited to direct pay, reimbursements and fast track maternity.
Ensures that there is a pre-authorization on file for invasive procedures, the insured is responsible for 30% of the claim if no preauthorization exists, unless other arrangements were approved by the director of the medical service team.
Determine if claims submitted are subject to coordination of benefits from other insurance coverage.
Obtain administrative decision approval for all claims approved to be paid by the medical service team outside the scope of the policy benefits and limitations.
Ensure that there is a preauthorization on file for invasive procedures, the insured is responsible for 30% of the claim if no preauthorization exists