Senior Officer – Claims

Job Description

• Manage daily claims review, processing, and auditing of claims in line with claims target.
• Maintain accuracy and consistency of data with appropriate review & auditing in line with coding & billing standards and evidence based clinical guidelines.
• Identify any Fraud waste and abuse practices in claims and engage in mitigation measures as per standard Operating Procedures.
• Provide training and coaching to the Junior claims staff for continued learning and enhancements.
• Deliver quality and time bound projects related to claims business process enhancements.
• Forward approved & audited claims to PICs (Partner Insurance Companies) for their approval as per thresholds.
• Review and respond to claims audits of clients and Internal audits.
• To prepare and provide reports related to TAT, Team Performance, Audits to the Team Lead or Department Head.
• Effectively handle internal and external communication politely, and professionally.

Your profile:

• Bachelor’s Degree holder of Medical / Dental / Paramedical Nursing, Physiotherapy / Pharmaceutical Sciences.
• Certified professional coder (CPC)
• Certified professional Medical Auditor is an added advantage (CPMA)
• 3-5 years of claims experience in a reputable Healthcare field / Insurance industry or TPA/MSO Company.
• Excellent interpersonal and communication skills
• Working on split or straight shifts according to business needs.
• Computer Literate with advanced knowledge of Microsoft packages (Word, PowerPoint, and Excel) e-mail, electronic calendar, and the Internet.
• Ability to work well with all levels of internal management and staff, as well as outside clients.