Duties and Responsibilities
- Review and process health insurance claims in line with the policy terms, ensuring regulatory compliance.
- Evaluate claim details for completeness and resolve issues by collaborating with insurance providers, policyholders, and internal teams.
- Investigate claim discrepancies and denials, working closely with all parties to facilitate prompt and accurate resolutions.
- Monitor claim status and ensure timely follow-up on unpaid or pending claims.
- Maintain accurate and detailed records of claims processed, communications, and outcomes.
- Collaborate with internal departments to ensure smooth claim processing and resolution.
- Effectively handle escalated claims from policyholders and other external partners that require advanced knowledge or decision-making.
- Other duties as assigned from time to time
Desired Skills and Experience:
- Bachelor’s degree in Healthcare Administration, Business, or a related field.
- Experience in health insurance claims processing, medical billing, or a related healthcare field.
- Confident in providing prompt and consistent administrative service support.
- Strong analytical, problem-solving, and critical thinking skills. Strong attention to detail and keen sense of accuracy.
- Excellent verbal and written communication skills, with the ability to interact effectively with policyholders, providers, and team members.
- Ability to learn and adapt quickly, and thrive in a high-pressure environment.
- Ability to work on own initiative as well as being a team player.
- Patient, empathetic, adaptable, and flexible.
