The Claims Officer role at Guru Nanak Ramgarhia Sikh Hospital is dedicated to the meticulous management and processing of patient claims and invoices. The hospital is known for its commitment to providing wholesome care that addresses the spiritual, physical, and emotional needs of patients. The Claims Officer ensures accuracy, completeness, and timely submission to insurance companies and clients while strictly adhering to internal Standard Operating Procedures (SOPs).
Key Responsibilities:
- Ensure all invoices and claims from the Outpatient Clinic and Inpatient Billing Clerks Office are received in the Finance Claims Office as per the SOPs.
- Ensure all IDS (Internal Dispatch Summary Reports) are acknowledged via signing and a copy sent/scanned and emailed to the billing clerk's office on a weekly basis.
- Ensure completeness and accuracy of claims and invoices, verifying they include signing by the doctor and client, presence of diagnosis, membership/policy number, claims are within the limit, and presence of smart reports where applicable.
- Ensure all EDS (External Dispatch Summary Report) are acknowledged/stamped received by the respective Insurance/Client contact person and a copy sent back and received by the Finance Claims Office daily. This stamped external dispatch report must be scanned and saved in the claims cloud folder and a hard copy filed.
- Maintain details of the contact person at each insurance who is responsible for receiving and confirming receipts of invoices and claims dispatched.
- Submitting monthly reports on the status of designated insurance and internal dispatch reports.
- Ensure adherence to the laid down SOPs in Claims management.
- Ensure that all the insurance company requirements are met before claims are submitted.
- Participate in preparation or implementation of a project of choice within the group operations during the year, specifically MED 360.
- Ensure claims functions and reports in the system are working properly and continuously.
Qualifications & Experience:
- Degree in Finance or Accounting or ACCA Part 2/CPA K Part/Sec 2 or above.
- 2 years accounting experience preferably in a hospital setup.
Key Competencies:
- Must have strong work ethics.
- Good mathematical background.
- Proficient in Excel and Word and experience with automated accounting systems.
- Ability to sort, check, count, and verify numbers.
- Ability to multi-task, prioritize and work efficiently.
