Medical Claims Officer

Key Responsibilities

• Process outpatient claims daily in adherence to medical policies and guidelines.
• Review claims data (physical and electronic) to ensure accuracy and compliance with operational checklists.
• Maintain accuracy rate in quality audits and meet daily processing targets.
• Identify unusual provider patterns and escalate potential fraud to the Supervisor of Medical Claims and Special Investigations Unit (SIU).
• Collaborate with senior staff on complex claims cases to ensure sound medical decisions.

Qualifications

Education:

• Bachelor’s degree in Dental, Physiotherapy, Pharmacy, or a related medical field.

Experience:

• A minimum of 2 years in health insurance is preferred.
• Fresh graduates with relevant educational backgrounds are encouraged to apply.

Skills

• Strong analytical, quantitative, and problem-solving skills.
• Excellent communication, interpersonal, and organizational abilities.
• High level of self-motivation and a proactive approach to challenges.