Job Description:

• Claim Processing: Review, audit, and process claims transactions within agreed Service Level Agreements (SLAs), ensuring compliance with policy terms and conditions.
• Documentation & Verification: Collect, verify, and validate all required documentation (e.g., invoices, medical reports) to ensure accuracy before submission.
• System Entry: Accurately input claim details into company databases or claims management software.
• Customer Service & Liaison: Communicate with policyholders, claimants, and healthcare providers to gather information, answer questions, and explain claim decisions.
• Follow-Up & Resolution: Follow up on pending or outstanding claims with underwriters or third-party providers.
• Compliance & Fraud Detection: Adhere to insurance regulations, company policies, and detect potential fraud during review. 
   

• Experience: 1–2 years in claims processing, insurance, or administrative roles.
• Technical Skills: Proficiency in MS Office Suite and claims management software.
• Knowledge: Understanding of insurance policy terms, medical terminology, and billing codes.
• Competencies: Strong analytical, communication, and time-management skills.

Industry:

HealthCare

Category:

Health

Skills: