Claims Processor

The job holder is responsible for serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests, and maintaining databases.

Responsibilities and Duties

• Process claims from providers and assess them in line with policy coverage and medical necessity.
• Be fully versed with medical insurance policies for various groups and beneficiaries.
• Accurately assess eligibility within policy boundaries and monitor claims processing.
• Achieve required processing targets assigned by the team leader.
• Monitor qualitative and quantitative measures for claims and pre-approvals.
• Ensure compliance with changes in system parameters or processes.
• Maintain quality and productivity, and respond to allocated work.
• Collaborate with stakeholders to resolve queries, including complex ones.
• Actively support team members to achieve operational goals.
• Meet or exceed Service Level Agreement requirements, team KPIs, and monthly quality audit scores.

Knowledge, Skills, and Experience

• At least 1-2 years of experience in a similar role.
• Experience working for an international company is preferred.
• Claims processing or insurance experience is preferred.
• Broad awareness of medical terminology is advantageous.
• Excellent organisational skills and strong administration awareness are essential.
• Strong skills in Microsoft Office applications and first-class written and verbal communication skills are essential.
• Ability to communicate across a diverse population and work independently or as part of a team.