Summary
Date Posted: Thursday, June 02, 2022 , Base Salary: Not Disclosed

JOB DETAILS:
Medical Claims Officer

Reports To Finance Manager

JOB SUMMARY
In this position, you are required to ensure the completeness and accuracy of all the Insurance Billings on a daily basis, follow up, and submissions of all insurance Claims and rejections.

Main Responsibilities
• Ensure all claims are vetted and audit claims received on a monthly basis.
• Oversee claims daily operations to ensure accuracy and completeness of each patient File.
• Ensure that all medical diagnostic related rejections are minimized to a zero percent and a monthly rejection report is submitted to the finance manager.
• Frequently give back to the affiliate doctors/specialist and all other stake holders on Insurance exclusions and limits.
• To be responsible for reconciling disputed claims with the respective doctors.
• To internally source for medical explanations from the respective personalities/officers to be able to explain any claims rejections and assist the credit controller in resubmitting them to the Insurance Companies for payment.
• To regularly Liaise with the Insurance Companies and be able to meet and explain any variances in the Claims.
• To perform any other duties that may arise in line with this role or the function it supports and as assigned from time to time.

Key Deliverables
• Assess claim forms daily to ensure proper billing and completeness
• Ensure submission of claims by 5th of every month
• Eliminate rejection of claims to 0%
• Evaluates claims with regards to eligibility
• Coordinates workflow & meet all deadline

Critical Success Factors For The Job

Qualifications & Certifications
• Diploma in Clinical Medicine or bachelor’s in medicine being an added advantage.
• At least Three to Five years’ experience as a Claims Officer
• Willingness to work a flexible schedule and fill in when required
• Excellent communication skills
• Proficient computer skills
• Good working knowledge of healthcare Insurance
• Accurate and precise attention to detail
• Ability to work well with management and staff at all levels

Job Experience: No Requirements

Work Hours: 8

Level of Education: Associate Degree

Job application procedure
To apply for this job email your details to hr@unfilteredpathways.com 

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