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.