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Medical Claims Specialist
2 weeks ago
We are seeking a dynamic professional to join our claims team in the healthcare industry.
Key responsibilities include:
- Providing accurate and efficient adjudication of claims, validation, pre-authorisation of applications, and log issuance to meet operational and service level agreement targets.
- Conducting regular review of current claims processes and working with internal stakeholders on developing new and improved processes to enhance efficiency and overall claims experience.
- Managing escalations and stakeholder relations.
- Being a champion for change and providing ongoing training and development for effective claims management.
Liaising with insurance companies to verify exceptions and resolve any complaints is also an essential part of this role. Additionally, conducting analysis, preparing periodic reports, and presenting when required will be key tasks.
Required Skills and Qualifications- 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 attention to detail.
- Passion for driving change to improve business outcomes.
- Exceptional communication skills and stakeholder management skills.
This role offers a unique opportunity to make a significant impact on the claims process and contribute to the success of our organisation.
How to ApplyFor more information about this role and how to apply, please contact us directly.
