Medical Claims Officer

Qualifications & Experience

• Bachelor’s degree in Finance, Accounting, Business Administration, or related field.
  
• Diploma in Clinical Medicine & Surgery or Diploma in Community Nursing
  
• Professional certification in Medical Billing & Coding, Health Economics, Health Management
  
• Systems or equivalent is an added advantage.
  
• Minimum of 3 years’ experience in medical claims management, billing, or healthcare finance (hospital setting preferred).
  
• Knowledge of Social Health Authority guidelines, insurance claims processes, and hospital billing systems.
  

Claims Management

• Prepare, review, and submit all hospital claims to insurance companies, SHA, and other contracted third parties within stipulated timelines.
  
• Ensure claims are prepared in accordance with signed MoUs, contracts, and prevailing guidelines.
  
• Verify accuracy and completeness of patient information, medical records, coding, and billing before submission.
  
• Track and follow up on pending claims, rejections, and underpayments to ensure timely settlement.
  

Documentation & Compliance

• Maintain accurate and up-to-date claims records, databases, and filing systems.
  
• Ensure adherence to all regulatory, hospital, and insurer requirements.
  
• Liaise with internal stakeholders (Clinical, Billing, Records, and ICT departments) to resolve claimrelated queries.
  
• Ensure compliance with SHA/insurance reporting and audit requirements.
  

Financial Accountability

• Reconcile claims submitted versus payments received and highlight variances.
  
• Identify and escalate financial exposure risks arising from delayed, rejected, or disputed claims.
  
• Support the Finance Manager in revenue analysis, reporting, and forecasting based on claims performance.
  

Stakeholder Engagement

• Act as the key contact between the hospital and insurance providers/SHA on claims-related matters.
  
• Work closely with the Finance Manager to negotiate and review claims settlement processes.
  
• Provide regular updates and reports on claims status to management.