Job Req ID:
1390
Senior Officer
- Review, verify, and adjudicate OPD and IPD claims in line with approved policy terms, conditions, and regulatory guidelines.
- Ensure accurate claim settlement as per defined processes and internal controls.
- Identify incomplete documentation or discrepancies and coordinate with providers/clients to resolve them.
- Process claims within agreed Turnaround Time (TAT) and Service Level Agreements (SLAs).
- Maintain strict adherence to internal audit and quality assurance requirements.
- Respond promptly and professionally to email queries, client inquiries, and provider clarifications.
- Prepare and share claim status reports, utilization summaries with clients and supervisors as required.
- Provide guidance on claim submission requirements to clients.
- Maintain an up-to-date claims log, ensuring accuracy and completeness of data.
- Track and document disbursement of claim settlement cheques/payments to clients and providers.
- Assist in preparing monthly, quarterly, and annual reports.