Claims Processing Officer

Key responsibilities/What you do:

• Audit and process all types of providers’ bills.
• Examine claim documents thoroughly.
• Ensure correct pricing is applied before processing bills in TATSH.
• Handle claim adjustments.
• Utilize AI-based screening tools to verify accurate entry of insurance claim information, ensuring precise processing and timely payment.
• Verify all required fields in TATSH, such as visa notes, precertification center notes, contract notes, policy files, medical files, and faxes, to guarantee accurate processing.
• Process and record invoice details in TATSH according to policy terms, product type, TOB, and information from medical auditors, providers, and precertification officers.
• Follow up daily on pending claims or issues with relevant departments until resolved.
• Notify the Network department upon receiving jumbo claims to secure special discounts from providers.
• Report in writing to the Network department any deviations from agreed tariffs by providers.
• Inform the Team Leader or Manager in writing about complaints related to payers’ or providers’ invoices received by the Claims Processing department.
• Communicate in writing to the Team Leader or Manager any requests or information needed from other departments.
• Adhere strictly to the Department’s internal procedures.
• Maintain confidentiality and proper management of insured member data, system information, policies, and medical records.
• Perform any other duties assigned by the Direct Manage

Key requirements/What you bring:

• Education: Pharmacy Degree.
• Experience: Minimum 2 years in the Health Care Industry, including TPA’s, insurance companies, hospitals, or medical centers.
• Strong commitment to delivering results.
• Ability to meet deadlines consistently.
• Excellent teamwork skills.
• Outstanding communication and organizational abilities.
• Flexibility to work shifts.
• Willingness to work overtime when necessary.
• Basic proficiency in MS Office applications.