Case Management (CMT)

As Case Management (CMT) each day you'll be..Administrative & Eligibility Verification.Review diagnoses and medical procedures based on supporting documents (Eligibility Letter, medical resume, lab results, etc.).Ensure treatment are aligned with medical indications and underwriting rules.Provide approval to TPA in accordance with limits and policy terms.Communicate directly with TPA and providers (hospitals/clinics) (if needed) and regarding guarantee detail.Ensure the guarantee SLA is met (fast, accurate, and within target response times).RequirementsAssociate Degree or Bachelor degree in health/nursing/or related.Have 3-5 years of similar experience as CMT in TPA or insurance industry.Excellent communication and interpersonal skills.Problem-solving and decision-making skills.Attention to detail.