PACIS Insurance Company Limited is looking for an Assistant Medical Claims Analyst. The purpose of this role is to evaluate medical claims submitted to the company and determine whether they meet the eligibility standards of the organization. The successful candidate will also be responsible for reconciling provider statements and scheduling their payments.
Key Responsibilities
Claims Processing and Provider Reconciliation
Receive invoices from various service providers and register them into the system.
Verify and audit all medical claims to ensure supporting documents are attached and follow up on documents not submitted with service providers/clients.
Accurately capture all invoices in the system.
Perform prompt account reconciliation and sign-offs with service providers and address all disputes to completion.
Recommend appropriate payment of disputed billing as necessary.
Negotiate and schedule monthly medical payments for approval.
Prepare and send payment remittances.
Prepare monthly claims, reconciliation, and sign-off reports for management.
Customer Service
Respond to client queries via telephone, calls, emails, and walk-in clients.
Build and enhance relationships with providers to ensure the Pacis Insurance account with providers is current and active.
Ensure adherence to contracts and service level agreements (SLAs) between providers and the company.
Requirements
Minimum Academic Qualification
Degree in a Business-related course, Statistics, or Accounts.
Professional Qualifications
Diploma in Insurance (IIK) is an added advantage.
Experience
At least 1 year of experience in the claims section of a health insurance department.
Knowledge
Strong understanding of the insurance industry.
How to Apply
Interested and qualified candidates should apply online via the link below or through the company website.
