Claims Reviewer

Job Purpose / Objective:

Responsible for all aspects of medical request approval, rejection and review claims on a daily basis to companies and insurance companies and monitors application data entry of company and insurance company policies

Key Responsibilities / Accountabilities:

• Responsible for checking and reviewing of claims for monthly claims submission.
• Reviews claims rejection.
• Prepares correspondence justifying rejected claims.
• Prepares medical report as per requested by the insurance companies.
• Coordinates with physicians regarding re-explanation on rejected claims.
• Check on daily/ weekly basis the Outcome of each Claim Processors, the perfection of the claim, the attachment, etc.
• Perform administrative tasks when required.
• Train and guide new staff.
• Participate in person-centered care initiatives undertaken by HMG.
• Enrich patient experience with compassion, respect and dignity.
• Perform other applicable tasks and duties assigned within the realm of his/her knowledge, skills and abilities.

Education/ Professional Qualification:

• Bachelor’s Degree Healthcare or insurance related

Experience:

• Minimum of two years’ experience in dealing with medical insurance

Professional Licensing / Certification / Training:

• N/A