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CLAIMS OFFICER

full-time North Ridge 07 Jul 2025

Our client is seeking to hire an experienced individual with deep industry knowledge in the health insurance field to handle insurance claims for the client in the capacity of a CLAIMS OFFICER.

ROLE PROFILE

The ideal candidate will be ensuring the smooth and efficient processing of insurance claims while maintaining high standards of accuracy, compliance, and customer satisfaction. He or she will perform the following duties as well:

DUTIES/RESPONSIBILITIES:

  • Examine submitted claims for completeness, accuracy, and compliance with policy terms
  • Verify the eligibility of policyholders and beneficiaries
  • Determine coverage based on policy provisions and medical necessity
  • Make decisions on claim approvals or denials
  • Calculate and authorize payments for approved claims
  • Identify and address discrepancies or inconsistencies in claim information
  • Respond to inquiries from policyholders, healthcare providers, and internal departments
  • Coordinate with medical professionals or external reviewers to obtain additional information or clarification
  • Liaise with other departments such as underwriting and customer service as needed
  • Identify and investigate potential fraudulent claims
  • Implement preventive measures to detect and reduce fraudulent activity
  • Ensure adherence to all relevant laws, regulations, and internal policies
  • Maintain accurate and up-to-date records and documentation

EDUCATION/EXPERIENCE

  • A minimum of a Degree in Healthcare Administration, Health Information Management, or a related field from a recognized institution.
  • A minimum of 2 years of relevant working experience in the health insurance industry or a similar role.
  • A minimum degree in Physician Assistant Studies is an advantage.

REQUIREMENTS

  • Excellent interpersonal and communication skills.
  • Must be able to multitask and prioritize tasks in a fast-paced environment.
  • Excellent organizational skills with ability to organise and plan work both independently and for tea
  • Proficiency in office management software (Google Workspace, Office 365).
  • Must pay attention to details and be proactive and Innovative with good initiative, drive and result oriented.
  • Knowledge of healthcare terminology and medical procedures.
  • Understanding of insurance principles and regulations.
  • Proficiency in using claims processing software and systems.
  • Must be a good team player and have problem-solving skills.

To apply, please send CVS to: claim.pjkt@gmail.com

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