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Job Description
- Performing technical audit on medical claims.
- Justifying the rejection reasons on system in rejection cases to facilitate the reconciliation process.
- Decision on high cost and complicated cases with providers.
- Proper implementation of agreements on claims in collaboration with the audit and processing team.
- Audit of invoice if it is under his job responsibilities.
- Coordination with other adjusters for distribution of the claims
- Escalation of any problematic area to Supervisor.
- Formulate and handle exceptions of claims.
- Report to management any irregularity noticed during the audit and/or closing of claims.
Job Requirements
- Must be graduated from Faculty of Medicine.
- From 1-3 years of experience in Medical insurance/TPA industry is a MUST
- Details oriented, Time management & Team-players.
- Males are preferred (Military Service should be exempted/completed)
- Very Good English Language skills is required.
- Strong communication skills.
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