Claims Management Assessor

Medical Claims Processing Officer is responsible for Processing the Claims within the regulatory TAT and quality requirements per the assigned checklist and according to Claims Allocation .

Summary:

Medical Claims Processing Officer is responsible for Processing the Claims within the regulatory TAT and quality requirements per the assigned checklist and according to Claims Allocation .

Main Tasks:

• Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention.
• Review and handle claims according to the established standard procedure.
• Support the team and departmental productivity goals to meet the agreed upon Service Level Agreement (SLA) and deliver exceptional customer service
• Provide accurate and professional responses to client inquiries, and if needed, collaborate with other departments to ensure prompt and efficient resolution.
• Engage in departmental medical training to broaden understanding of medical terminology and procedures, and enhance proficiency in claims processing skills.
• Ensures adaptability in various claims handling work-related tasks to be able to facilitate a multi-tasking role.
• Ensures that high quality targets (standard of work performance) are achieved at all times.
• Support the Team Leader to drive engagement within the Team
• Other Ad hoc duties as required

Minimum Requirements:

• Bachelor’s degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related field preferred.
• 1-2 years’ experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
• Proficiency in MS Office
• A highly customer-focused individual with strong interpersonal, communicative and accuracy skills.
• Team player
• Ability to demonstrate sound work ethics.
• Ability to work under pressure and to meet tight deadlines and service standards
• Legally permitted to work in the country of operations.
• Hybrid working option available as per business requirements.

Main Tasks:

• Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention.
• Review and handle claims according to the established standard procedure.
• Support the team and departmental productivity goals to meet the agreed upon Service Level Agreement (SLA) and deliver exceptional customer service
• Provide accurate and professional responses to client inquiries, and if needed, collaborate with other departments to ensure prompt and efficient resolution.
• Engage in departmental medical training to broaden understanding of medical terminology and procedures, and enhance proficiency in claims processing skills.
• Ensures adaptability in various claims handling work-related tasks to be able to facilitate a multi-tasking role.
• Ensures that high quality targets (standard of work performance) are achieved at all times.
• Support the Team Leader to drive engagement within the Team
• Other Ad hoc duties as required

Minimum Requirements:

• Bachelor’s degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related field preferred.
• 1-2 years’ experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
• Proficiency in MS Office
• A highly customer-focused individual with strong interpersonal, communicative and accuracy skills.
• Team player
• Ability to demonstrate sound work ethics.
• Ability to work under pressure and to meet tight deadlines and service standards
• Legally permitted to work in the country of operations.
• Hybrid working option available as per business requirements.