Job Description

We are seeking a dedicated and detail-oriented Medical Claims Officer to join our team, The role focuses on ensuring efficient and accurate adjudication of outpatient claims while maintaining compliance with regulatory standards.

Key Responsibilities

Process outpatient claims daily in adherence to medical policies and guidelines.
Review claims data (physical and electronic) to ensure accuracy and compliance with operational checklists.
Maintain accuracy rate in quality audits and meet daily processing targets.
Identify unusual provider patterns and escalate potential fraud to the Supervisor of Medical Claims and Special Investigations Unit (SIU).
Collaborate with senior staff on complex claims cases to ensure sound medical decisions.

Qualifications

Education:

Bachelor’s degree in Dental, Physiotherapy, Pharmacy, or a related medical field.

Experience:

A minimum of 2 years in health insurance is preferred.
Fresh graduates with relevant educational backgrounds are encouraged to apply.

Skills and Attributes

Strong analytical, quantitative, and problem-solving skills.
Excellent communication, interpersonal, and organizational abilities.
High level of self-motivation and a proactive approach to challenges.