Medical Claims officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards.​​

Medical 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.​

What you do

• Assesses approval of medical approvals as well as policy use.​

• Channels Medical Claims officers in handling difficult medical cases and optimize the quality and quantity output.​

• Monitors daily output on the number of case done and decrease in number of errors committed.​

• Checks particular treatment plan is necessary for the patient.​

• Inputs verbal and written claims approvals regularly.​

• Provides second opinion for cases where there is doubt in treatment plan.​

• Decides approvals as per policy conditions.​

• Assess high cost claims and provide decision on high cost and complicated cases. ​

• Provides clear feedback on queries from call Centre team.​

• Provides clients an understanding of any declined medical claims.​

• Manages routine daily claims administration work. ​

• Coordinates work flow & meet deadlines. ​

• Evaluates claims with regards to eligibility. ​

• Provides on job training to team members as necessary.

What you bring

• Bachelor’s of Medicine\Pharmacy\Dentistry ​

• 2+ years Medical Practical Experience (reputable insurance provider, broker or a TPAexperience 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 generalinternet navigation and research skills.

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