In this role, My responsibilities are monitoring, assessing, and evaluating members' utilization of services to ensure alignment with the coverage stipulated in their accounts. This involves obtaining, collecting, collating, processing, and reviewing all relevant patient data from doctors, nurses, patients, charts, and other necessary sources to adjudicate coverage accurately. I also conducts visits and follow-ups, engages in discussions, and ensures that inpatient members fully understand the limits and scope of their insurance benefits. Additionally, Monitors and update billing as necessary, analyze and compute potential excess charges that members might incur, and appropriately endorse coverage to providers based on their findings.
