JOB PURPOSE
To evaluate medical claims submitted to the company and determine whether claims meet eligibility standard of the company. • Reconcile provider statements and schedule their payments
PRINCIPAL ACCOUNTABILITIES
- Claims Processing and Provider Reconciliation:
- Receiving invoices form various service providers and registering them into system.
- Verifying and auditing all medical claims to ensure supporting documents are attached and following up of documents not submitted with service providers/clients.
- Accurate capturing of all invoices in the system.
- Prompt account reconciliation and sign offs with service providers and address all disputes to completion.
- Recommend appropriate payment of disputed billing as necessary
- Negotiate and schedule monthly medical payments for approval.
- Prepare and send payment remittances
- Prepare monthly claims, reconciliation and sign off reports for the management
Customer Service:
- Respond to client’s queries on telephone, calls, emails and walk in clients.
- Build and enhance relationship with providers to ensure Pacis
- Insurance account with the providers is current and active.
- Ensure adherence to contracts and service level agreements between providers and the company
Qualifications:
Minimum Academic Qualification:
- Degree in Business related course / Statistics/ Accounts
Professional Qualifications
- Diploma in Insurance IIK as an added advantage
Experience:
- 1 year experience in claims section of a health insurance department
Knowledge:
- Understanding of insurance industry
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