The Medical Claims - Officer will provide quality service to clients, promptly and effectively assesses and process OP claims according to operations set standards.
What You Do
- Manages routine daily claims administration work.
- Coordinates work flow & meet deadlines.
- Evaluates OP claims with regards to eligibility.
- Apply nextcare cost containment protocols for OP claims at the retrospective review level
- Attends calls and e-mails from insurance companies, clients, and providers.
- Makes suggestions to improve service.
- Increases efficiency, minimizes errors and administration time.
- Bachelor’s of Medicine / Nursing / Physiotherapist / Paramedics
- Medical Practical Experience (reputable insurance provider, broker or a TPA experience aplus) OR Entry Level
- Physically fit to carry out duties.
- Certified Medical Coder [Preferable]
- Legally permitted to work in the country of operations.
- Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and generalinternet navigation and research skills
- Organizational & time management skills.
- Excellent team player.
- Ability to work well with all levels of internal management and staff, aswell as outside clients and users.
- Ability to demonstrate sound work ethics.
- Show flexibility with excellent interpersonal skills.
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