We're looking for a Claims officer to provide quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. Claims officer is also responsible for team success by agreeing, implementing and monitoring individual and team objectives and targets ensuring company policies and procedures are adhered to.
Job Responsibilities:
- Evaluates medical claims from the technical and medical perspectives as per policy terms and conditions.
- Channels claims officers in handling difficult medical cases and optimize the quality and quantity output.
- Checks particular treatment plan is necessary for the patient.
- Analyse providr Abuse,pattern and Trend.
- Good Analysis of Fraud,waste and abuse.
- Refers for a second opinion for cases where there is doubt in treatment plan.
- Provides clients an understanding of any declined medical claims.
- Maintains daily productivity targets and service levels.
- Manages routine daily claims administration work.
- Coordinates work flow & meet deadlines.
Job Requirements:
- Bachelor’s of Medicine ( MBBS ) ,BDS or Pharmacy or Nurse.
- 2+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).
- Physically fit to carry out duties.
- Legally permitted to work in the country of operations.
- Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
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