Claims Adjustor

Job Description and Requirements


REPORTING TO: Claims & Processing Manager.

QUALIFICATION REQUIREMENT:

Degree on Science, Medicine or Health related profession. Experience on processing claims.



YEARS OF EXPERIENCE:

One year and above.



JOB SUMMARY:

Review & processed the claims and assess the coverage based on the policy wording and the contractual agreement with both provider and insurance company on timely manner.



DUTIES & RESPONSIBILITIES:
•Receives claims and invoices from the network of providers, the insurance clients, brokers and employers and ascertain their compliance with acceptance standards.
•Review claims medically with the support of the medical doctors.
•Adjust and re-price claims as per policy benefits and agreed to tariffs.
•Process claims on the company's healthcare benefits management system.
•Validate, close and issue Bordeaux with the support of the Supervisor.
•On need basis, support the company's call center in regards to pre-approvals and information to callers.
•File the original documents and assure they are sent to the respective risk carrier after processing the same.



REPORTING TASK:
•The Claims Adjuster shall be reporting to the Claims Processing Manager.

MEASURING PERFORMANCE:
•Must able to meet deadline required in achieving set objectives and initiatives in processing claims delegated by Claims processing manager.