For our client, an international company from insurance healthcare services field, we are looking for a Claims Officer (remote work), for their new call center department. The candidates could be based across Romania.

Main responsabilities:
• Telephone clarification of the customer/provider/mediator;
• Management of complaints;
• Management of pre-authorization processes;
• Management of reimbursement processes;
• Management of providers invoices processes.

Main tasks:
• Service of customers/providers/brokers;
• Handling of emails from customers/providers/brokers;
• Issue authorisation requests in the system;
• Examine applications for pre-authorisation and issue a decision in cases that do not need clinical analysis;
• Perform the relationship with the medical department in cases of authorization that require medical analysis;
• Issue claims for reimbursement/ indemnity;
• Review claims and issue a decision in cases that do not need clinical review;
• Perform dialogue with the medical department in cases of reimbursement that require medical analysis;
• Review pre-invoices and invoices from providers, relating to the previously issued authorization information;
• Follow-up reports for companies and operations direction.

Requirements:
• Experience in similar position as customer care representative (healthcare/life insurances is an advantage);
• Medicine/nursing educational background is a great plus;
• Technical knowledge of health insurance market/medicine/nursing;
• Knowledge of English (min. conversational level);
• Availability for remote work.