Claims Officer/ Supervisor

About the role

The Claims Officer (PS4) is responsible for processing and analyzing medical and life insurance claims using prescribed processes and existing policy contracts and guidelines. The role involves verifying claim details, preparing transmittals for payment, approving claims within authority limits, and reconciling claims with providers. The Claims Officer also conducts user acceptance testing (UAT) of system enhancements, provides customer service regarding claims status and payment inquiries, reconciles provider statements of account, and maintains effective relationships with assigned accounts through regular coordination and timely resolution of claims-related concerns.

Key responsibilities

• Check availability and accuracy of claims details in MAS and make necessary corrections
• Verify unlisted claims in MAS with biller and Alarm Center
• Process and analyze claims using prescribed processes and based on existing policy contract and guidelines
• Prepare transmittal of claims for payment
• Approve payment for claims within authority limit
• Recommend approval of claims payment beyond authority limit
• Reconcile claims with providers and accounts
• Conduct UAT of system enhancements and provide analysis and findings
• Answer inquiries via email or phone regarding status of claims or overdue payments within set turn-around time
• Document, resolve, or escalate claims disputes or complaints within TAT

About you

• College graduate with a degree in any medical or business-related discipline
• At least 5 years' experience in medical or life claims processing
• At least 2 – 3 years' experience at officer or supervisory level
• Preferably passed Life Office Management Association (LOMA) courses