• Responsible for analyzing, adjudicating, auditing, and processing of claims (In-Patient, Outpatient Hospital Bills and Professional Fees) according to set medical guidelines, policies within the agreed SLAs (Service Level of Agreements)
• Analyze claim submissions to verify policyholder and provider information, ensuring accuracy and completeness against submitted documentation. 
• Liaise with clients, insurance agents, beneficiaries, healthcare providers, and other departments to gather information, resolve issues, and provide updates on claim status. 
• Prepare and maintain accurate records of all claim activities and policy information, often using specialized database systems. 
• Determine policy coverage, calculate the appropriate claim amounts, and process payments or other reimbursements. 
• Ensure all claim processing activities adhere to company policies, procedures, and relevant state and federal regulations. 
• Investigate and resolve any discrepancies or issues that arise during the claim process. 

Qualifications

• Graduate of any 4-year course.
• Fresh graduates are welcome to apply.