Insurance Claims & Reconciliation Officer

Qualifications:

• Bachelor’s degree in Accounting, Finance, Business Administration, or related field;
  
• Professional qualification such as CPA, ACCA, or equivalent is an added advantage;
  
• A nurse or clinical officer with experience in medical insurance claims management in a reputable insurance company will also be considered;
  
• At least 3–5 years’ experience in insurance claims processing, healthcare finance, or medical billing;
  
• Strong understanding of insurance claim cycles, healthcare schemes, and billing processes;
  
• Proficiency in MS Excel, accounting systems, and ERP platforms;
  
• Previous experience in a hospital or insurance company environment preferred;
  

Claims Management

• Collect, verify, and prepare insurance claims with supporting documents (invoices, pre-authorizations, medical reports);
  
• Submit claims to insurers within stipulated timelines and monitor acknowledgment of receipt;
  
• Track claims at every stage to ensure timely settlement;
  
• Maintain an updated claims register with details of claims submitted, amounts, dates, and statuses;
  

Reconciliation & Payment Processing

• Reconcile insurer remittances against submitted claims, ensuring accuracy and completeness;
  
• Investigate and resolve variances, rejections, partial payments, or delays in settlement;
  
• Prepare reconciliation statements and submit to the Finance Manager;
  
• Work with Accounts Receivable to ensure insurance payments are correctly posted;
  

Follow-Up & Dispute Resolution

• Liaise with insurance companies and third-party administrators to resolve disputed or pending claims;
  
• Escalate unresolved claim issues to management for intervention;
  
• Maintain strong working relationships with insurer contacts to facilitate quick resolution;
  

Compliance & Risk Management

• Ensure all claims adhere to hospital policies, insurer requirements, and regulatory standards;
  
• Monitor and report on trends in claim rejections or denials, recommending preventive measures;
  
• Safeguard confidentiality of patient and insurer information in line with data protection regulations;
  

Reporting & Analysis

• Prepare periodic reports on claims submitted, amounts recovered, outstanding balances, and rejection trends;
  
• Provide management with insights on performance of different insurers and highlight areas of concern;
  
• Support preparation of monthly, quarterly, and annual financial reports related to insurance recoveries;
  

Stakeholder Coordination & Process Improvement

• Collaborate with clinical, billing, and administrative teams to ensure accurate patient data and claim documentation;
  
• Train or sensitize staff on proper documentation practices to reduce claim rejections;
  
• Recommend process improvements to reduce turnaround times and increase claim recovery efficiency;
  
• Keep updated with changes in insurance policies, tariffs, and regulations, and advise management accordingly;
  
• Any other duties as may be assigned.