AVP, Pre-Claims Authorization Assessment (Medical Care Concierge Team) at Great Eastern Life Assurance Co Ltd

Cuenca, Azuay, Ecuador -

Full Time

Start Date

Immediate

Expiry Date

06 Jan, 26

Salary

0.0

Posted On

08 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Problem Solving, Communication, Stakeholder Management, Customer Service, Healthcare Administration, Insurance Claims, Pre-Claims Authorization, Regulatory Compliance, Risk Management, Medical Professional Liaison, Service Standards, Case Resolution, Investigation Management, Appeals Management, Alternative Solutions, Ad-Hoc Projects

Industry

Insurance

Description

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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Responsibilities

The role involves ensuring accurate and timely assessment of pre-claims authorization requests while managing pre-claim investigations and liaising with medical professionals. It also includes resolving escalated cases promptly to meet or exceed service standards.