Overview

The Claims Risk Management Specialist assesses the clinical and factual validity of claims submitted by medical organizations, as well as identifies and manages the risks arising in these processes.

Responsibilities:
  • Participate in Claims Risk Management activities
  • Analyze claims submitted by medical organizations and pharmacies, assessing their medical validity, appropriateness of diagnosis and treatment, and appropriateness of services.
  • Identify risk cases, including unfounded or unnecessary services, overuse of services, repetitive or inappropriate services.
  • Identify, assess, and classify risks in claims processes by type of medical organizations and services.
  • Conduct case studies and analyze systemic issues.
  • Identify and analyze potential abuses within the scope of medical service provision.
  • Compile and submit reports on identified risks, trends and problems.
  • Participate in discussions with representatives of medical organizations on identified problems and risks.
  • Prepare proposals, references, reports, reports and other writings as assigned by the team leader or department head.
Required Qualifications:
  • Higher medical education.
  • At least 4 years of professional experience.
  • Analytical thinking, decision-making skills.
  • Excellent communication and teamwork skills.
  • Experience working with regulatory documents.
  • Detail-oriented
  • Organizational skills
  • Risk assessment
  • Medical education
Additional Information:

What we offer

  • Stable work in a reputable and developing organization
  • Paid Day-offs and Sick leaves
  • Opportunity for professional growth and continuous training
  • Comfortable, organized and supportive work environment
  • Corporate culture based on mutual respect and professionalism

 

Note:

✨ Our intelligent job search engine discovered this job and republished it for your convenience.
Please be aware that the job information may be incorrect or incomplete. The job announcement remains the property of its original publisher. To view the original job and its full details, please visit the job's URL on the owner’s page.

Please clearly mention that you have heard of this job opportunity on https://ijob.am.