The Claims Processing Officer reviews and audits providers’ bills, accurately entering them into the system. They scan for missing documents and verify that medical reports, prescriptions, tests, and invoices are consistent.
Key responsibilities/What you do:
- Audit and process all types of providers’ bills.
- Examine claim documents thoroughly.
- Ensure correct pricing is applied before processing bills in TATSH.
- Handle claim adjustments.
- Utilize AI-based screening tools to verify accurate entry of insurance claim information, ensuring precise processing and timely payment.
- Verify all required fields in TATSH, such as visa notes, precertification center notes, contract notes, policy files, medical files, and faxes, to guarantee accurate processing.
- Process and record invoice details in TATSH according to policy terms, product type, TOB, and information from medical auditors, providers, and precertification officers.
- Follow up daily on pending claims or issues with relevant departments until resolved.
- Notify the Network department upon receiving jumbo claims to secure special discounts from providers.
- Report in writing to the Network department any deviations from agreed tariffs by providers.
- Inform the Team Leader or Manager in writing about complaints related to payers’ or providers’ invoices received by the Claims Processing department.
- Communicate in writing to the Team Leader or Manager any requests or information needed from other departments.
- Adhere strictly to the Department’s internal procedures.
- Maintain confidentiality and proper management of insured member data, system information, policies, and medical records.
- Perform any other duties assigned by the Direct Manage
Key requirements/What you bring:
- Education: Pharmacy Degree.
- Experience: Minimum 2 years in the Health Care Industry, including TPA’s, insurance companies, hospitals, or medical centers.
- Strong commitment to delivering results.
- Ability to meet deadlines consistently.
- Excellent teamwork skills.
- Outstanding communication and organizational abilities.
- Flexibility to work shifts.
- Willingness to work overtime when necessary.
- Basic proficiency in MS Office applications.
