Quick summary
Job Overview
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Date PostedNovember 12, 2026
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Job TypeFull Time
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GenderBoth
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ExperienceAt least 1-2 years relevant work experience doing internal quality assurance audits.; Experience in data analytics and reporting.; At least 1-2 years relevant work experience
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QualificationBachelor’s degree in Medicine, Pharmacy, or Dentistry.
Job Description
Your Job:
- Provide overall guidance about the medical cases review, evaluation and claims activities ensuring compliance with established policy guidelines.
- Review all KPI’s and SLA’s and process in place for all reviewed claims.
- Monitor and review the claims process in terms of TAT and accuracy (technical and medical).
- Follow up on the team’s performance regarding quality projects.
- Monitor and verify team member communications with stakeholders in terms of claims and responses via email or calls.
- Identifying and resolving workflow and production, process, or product issues, and presenting solutions.
- Conduct audit testing and prepare and present audit findings.
- Evaluate audit findings and implement appropriate corrective actions and assist in the identification of potential process inefficiencies.
- Identify training needs required to meet quality standards and assist in creating training materials and operating manuals.
Your Profile:
- Bachelor’s degree in Medicine, Pharmacy, or Dentistry.
- Previous work experience in the insurance industry is a must.
- At least 1-2 years relevant work experience doing internal quality assurance audits.
- Experience in data analytics and reporting.
- Excellent command of MS Excel.
- Very Good Analytical and Reporting Skills
- Good interpersonal and negotiation skills.
- Excellent written and verbal communication skills.
- Analytical and problem-solving skills.
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