Medical Claims Analyst

Who We’re Looking For

Essential Knowledge/Skills and Experience Required:

• Bachelor’s degree in a related field or a Diploma in Nursing / Diploma in Clinical Medicine.
  

• Minimum of 3 years of relevant experience.
  

• Registered Nursing, Diploma – Required
  

• Excellent communication and presentation skills
  

• Vet in/outpatient medical bills/invoices and refer any suspicious claims to the supervisor;
  

• Batch outpatient invoices on the system and adjust amount payable as per the vetting findings;
  

• Check and reject incomplete invoices and return with supporting documents to service providers.
  

• Negotiate, adjust and update service providers on their costs and accounts status;
  

• Reconcile statements of accounts for service providers; advising accounts and service providers on unpaid/underpaid bills;
  

• Review claims reserves on a continuous basis in view of new developments;
  

• Attend to customer queries and complaints promptly and professionally and
  

• Recommend risk improvement measures to the underwriter to take appropriate action.