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Clinical Claims Professional
2 weeks ago
Job Title: Clinical Claims Professional
Job Description:We are seeking a dynamic and skilled Clinical Claims Professional to join our corporate managed healthcare business. The successful candidate will be responsible for providing accurate and efficient adjudication of claims, validation, pre-authorisation of applications, and issuance of LOGs to meet operational and SLA targets.
- Provide accurate and efficient adjudication of claims, validation, pre-authorisation of applications, and LOG issuance to meet operational and SLA targets
- Conduct regular review of current claims processes and work with internal stakeholders on developing new and improved processes to improve efficiency and overall claims experience
- Manage escalations and stakeholder relations
- Be a champion for change and provide ongoing training and development for effective claims management
- Liaise with the Insurance Company to verify exceptions and resolve any complaints
- Conduct analysis, prepare periodic reports, and present when required
To be successful in this role, you will need:
- Strong technical understanding of the claims process for medical claims, preferably in a Third-Party Administrator/Managed Healthcare environment
- Highly developed interpersonal skills
- Excellent organisational skills and exceptional eye for detail
- Passion for driving change to improve business outcomes
- Exceptional communication skills and stakeholder management skills
This is an exciting opportunity to join a dynamic team and contribute to the success of our organisation. As a Clinical Claims Professional, you will have the opportunity to develop your skills and knowledge, work with a talented team, and make a real difference in the lives of our customers.
Interested applicants should click apply or send their resume to us. Only shortlisted candidates will be contacted.