Processing claim forms, adjudicate for provision of deductibles, co-pays, co-insurance maximums and provider settlements.
Entering claims data into the system.
Attending to queries from Members / PICs / Providers and resolving problems that results from claim settlement.
Performing audit of randomly selected claims to ensure quality processing and detect any frauds.
Researching claim overpayments and request funds.
Following adjudication policies and procedures to make sure proper payment of claims.
Providing timely and quality customer service to members, providers, and other insurance companies .
Maintaining and preparing departmental of records.
Diploma in business management or related degree with a Diploma in any of the Para-Medical Courses.
Minimum one year of experience in claims management in Insurance industry or TPA Company.
Basic knowledge of relational databases and excellent knowledge of MS Office.
