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Job Description
- Performing technical audit on medical claims
- Justifying the rejection reasons on the system in rejection cases to facilitate the reconciliation process.
- Proper implementation of agreements on claims in collaboration with the audit and processing team
- Audit of the invoice, if it is under his job responsibilities.
- Coordination with other adjusters for distribution of the claims
- Escalation of any problematic area to the Supervisor.
- Formulate and handle exceptions of claims.
- Report to CPD manager any irregularity noticed during the audit and/or closing of claims.
Job Requirements
- Bachelor's degree in Pharmaceutical Sciences or related medical background from a Reputable University is a MUST.
- From 1-3 years of experience in Medical insurance/TPA industry is a MUST
- Details oriented, Time management & Self-motivated competencies are required.
- Good to Very Good English Language skills are required.
- Ability to work individually and in a team
