Claims Processing Officer
LEBANON
Job description
The Claims Processing Officer reviews and audits providers’ bills, efficiently processing them within the system. They conduct thorough scans to detect any missing documents and verify that medical reports, prescriptions, tests, and invoices are consistent and accurate.
Key responsibilities/What you do:
- Audit and process all types of providers’ bills efficiently.
- Review claim documents thoroughly.
- Verify that accurate pricing is applied to bills before entering them into TATSH.
- Handle claim adjustments promptly.
- Ensure insurance claim information is correctly entered into the system to guarantee precise processing and timely submission to payers.
- Verify all required fields in TATSH, such as visa notes, precertification center notes, contract notes, policy files, medical files, and faxes, to ensure accurate processing.
- Process and record invoice details in TATSH according to policy terms, product type, TOB, and information provided by the medical auditor, provider, or Precertification officer.
- Conduct daily follow-ups on pending claims or issues with relevant departments until resolved.
- Achieve company-set targets consistently.
- Notify the Network department upon receiving jumbo claims as per agreed procedures to secure special discounts from providers.
- Report in writing to the Network department any deviations by providers regarding the agreed tariff application.
- Report in writing to the Team Leader/Manager about complaints received by the Claims Processing department related to payers’ or providers’ invoices.
- Communicate in writing to the Team Leader/Manager any information or tasks needed from other departments.
- Adhere strictly to the Department’s internal procedures.
- Ensure the confidential and proper management of insured members’ data, system information, policies, and medical records.
- Perform any additional duties assigned by the Direct Manager.
Key requirements/What you bring:
- Education: Bachelor Degree or equivalent
- Experience: 2+ years experience within the Health Care Industry (TPA’s, Insurance companies, Hospitals, Medical Centers)
- Demonstrate commitment to producing output base results
- Ability to respect deadlines
- Excellent team player.
- Excellent communication and organizing skills
- Flexible and ability to work shift
- Willing to work overtime when requested.
- Basic knowledge of MS Office applications