Medical Claims Administrator

About the Role

We are looking for a qualified and detail-oriented Medical Claims Administrator to join our team on an outsourced assignment. The role will be responsible for reviewing, processing, and assessing medical insurance claims while ensuring accuracy, timely resolution, and compliance with relevant healthcare and insurance guidelines.

Candidates with a healthcare background who have worked in a hospital, clinic, pharmacy, healthcare provider, or similar medical environment are encouraged to apply. Previous medical claims or insurance experience is preferred but not mandatory.

Key Responsibilities

• Receive, review, and process medical insurance claims submitted by policyholders and healthcare providers.
  
• Review claims against policy terms, coverage limits, and medical necessity criteria.
  
• Verify the accuracy and completeness of claim forms, medical records, invoices, and supporting documentation.
  
• Investigate questionable or incomplete claims by contacting healthcare providers and requesting additional information where required.
  
• Review and analyse medical records and supporting documents to support claim assessment.
  
• Make recommendations or decisions regarding claim approvals, denials, or requests for additional information in line with policy guidelines.
  
• Ensure timely and accurate processing of approved claims for payment.
  
• Coordinate with finance teams and third-party administrators when required.
  
• Communicate professionally with policyholders, healthcare providers, and internal stakeholders regarding claim status and required actions.
  
• Maintain accurate records of claims, correspondence, investigations, and outcomes.
  
• Ensure compliance with applicable healthcare regulations, medical coding standards, company policies, and procedures.
  
• Support the team in maintaining high standards of accuracy, confidentiality, and service quality.
  

Requirements

Benefits