Medical Claims Officer 09F25

The role of a Medical Claims Officer is integral within the healthcare insurance industry, focusing on the accurate processing and management of medical insurance claims. This position requires a detail-oriented individual with a strong understanding of medical terminology, insurance policies, and claims processing. The ideal candidate will possess excellent analytical skills, enabling them to review and assess claims efficiently and fairly. You will be responsible for liaising with medical professionals and policyholders, ensuring that all claims are handled promptly and in compliance with industry regulations. A Medical Claims Officer must maintain confidentiality and demonstrate a commitment to delivering high-quality service, fostering trust with clients and stakeholders.

Responsibilities

• Examine and process medical insurance claims accurately and efficiently.
• Verify the completion of claim documents and required medical information.
• Communicate with healthcare providers to obtain necessary claim details.
• Adjudicate claims in accordance with policy terms and conditions.
• Maintain detailed records of all claims processed and reviewed.
• Identify and flag suspicious or fraudulent claims for further investigation.
• Provide prompt and professional responses to inquiries from policyholders.
• Work closely with other departments to resolve claim-related issues effectively.
• Prepare detailed reports for management on claim activities and trends.
• Stay updated with current industry regulations and compliance requirements.
• Participate in training sessions and workshops to enhance claims knowledge.
• Assist in developing and implementing claims handling procedures.

Requirements

• Bachelor’s degree in healthcare administration, finance, or related field required.
• Proven experience in medical claims processing or insurance industry work.
• Strong knowledge of insurance policy terms and medical terminology.
• Excellent communication skills for dealing with clients and healthcare professionals.
• Proficiency in using claims management software and Microsoft Office Suite.
• Exceptional analytical skills with keen attention to detail and accuracy.
• Ability to maintain confidentiality and handle sensitive information responsibly.