Assistant Medical Claims Analyst

Qualifications:Minimum Academic Qualification:

• Degree in Business related course / Statistics/ Accounts
  

Professional Qualifications

• Diploma in Insurance IIK as an added advantage
  

Experience:

• 1 year experience in claims section of a health insurance department
  

Knowledge:

• Understanding of insurance industry
  

• Claims Processing and Provider Reconciliation:
  
• Receiving invoices form various service providers and registering them into system.
  
• Verifying and auditing all medical claims to ensure supporting documents are attached and following up of documents not submitted with service providers/clients.
  
• Accurate capturing of all invoices in the system.
  
• Prompt account reconciliation and sign offs with service providers and address all disputes to completion.
  
• Recommend appropriate payment of disputed billing as necessary
  
• Negotiate and schedule monthly medical payments for approval.
  
• Prepare and send payment remittances
  
• Prepare monthly claims, reconciliation and sign off reports for the management
  

Customer Service:

• Respond to client’s queries on telephone, calls, emails and walk in clients.
  
• Build and enhance relationship with providers to ensure Pacis
  
• Insurance account with the providers is current and active.
  
• Ensure adherence to contracts and service level agreements between providers and the company