Job Summary
To support the Medical Claims Manager by providing operational support in the medical claims processes and settle insurance claims in a fast, fair and courteous manner to ensure customer satisfaction, company profitability and a good corporate image.
Job Description
Claims vetting and approval
- Receiving and registering incoming claims.
- Claims adjudication.
- Analysing all patients’ claims (In terms of completeness and validity) and processing them for payment.
- Examining and confirming member benefits, entitlements and exclusions.
- Preparing member statements (on request) for clients regarding their policy benefit utilisation status.
- Preparing payment remittances and credit notes where applicable.
- Liaising with providers on claims queries.
- Prepare management reports.
Customer service, provider negotiations and reconciliation
- Handling customer queries (walk-in, phone & e-mail) regarding claims and payments
- Assist in reconciliation and attending reconciliation meetings with the providers
Education And Experience Required
- Bachelor’s degree in actuarial science or Diploma in pharmacy/Clinical medicine /Nursing/Laboratory and any other medical related course.
- COP (certificate of proficiency in Insurance) & ACII will be an added advantage.
- At least one year experience in a busy insurance related field.
- Strong analytical skills required.
Education
Further Education and Training Certificate (FETC): Business, Commerce and Management Studies (Required)
