Claims Staff

Qualifications

• Must be a graduate of any medical-related course (e.g., Nursing, Medical Technology, Biology, or equivalent).
• or at least with experience in HMO or health insurance claims (advantage but not required)
• Good attention to detail and analytical skills.
• Effective communication and coordination skills.
• Proficient in basic computer applications and documentation.

Key Responsibilities

• Review insurance claims for accuracy, completeness, and compliance with policy provisions.
• Verify policy details, member eligibility, and coverage inclusions/exclusions.
• Investigate claims by gathering and validating necessary information from claimants, healthcare providers, and other relevant parties.
• Evaluate claims in accordance with company policies and determine the extent of liability.
• Process approved claims, payments, and settlements in a timely and accurate manner.
• Communicate with claimants, policyholders, healthcare providers, and internal stakeholders to provide claim status updates and resolve concerns.
• Maintain accurate and up-to-date records of claims and related documentation.
• Perform other ad hoc tasks as may be assigned by the immediate superior.