Medical Claims Adjuster

Duties & Responsibilities:

• The In-claims Adjuster will be responsible of performing technical audit on IN Hospital bills and ensure an appropriate application of contracts, tariff agreements and NSSF rules.

 

Reimbursement claims:

• Create Reimbursement Visas (direct claims)
• Audit of invoice, if it is under his responsible area.
• Coordination with other adjusters for distribution of the claims
• Escalation of any problematic area to IN Hospital Supervisor.
• Formulate and handle exceptions of Reimbursement claims.
• Closing Reimbursement claims on weekly basisReport to CPD manager any irregularity noticed during the audit and/or closing of claims
• Clearing the system from all reimbursement claims once every 2 months, following to coordination with the corresponding guarantors.