Medical claims Officer - MCC

Job description

Description:

The Medical Claims - Officer will provide quality service to clients, promptly and effectively assesses and process OP claims according to operations set standards

Key responsibilities/What you do:

• Manages routine daily claims administration work. 
• Coordinates work flow & meet deadlines.
• Evaluates OP claims with regards to eligibility.
• Apply nextcare cost containment protocols for OP claims at the retrospective review level
• Attends calls and e-mails from insurance companies, clients, and providers.
• Makes suggestions to improve service.
• Increase efficiency, minimize errors, and reduce administration time through AI-powered automation.

Key requirements/What you bring

• Bachelor’s of Pharmacy / Dentistry / Medicine / Nursing / Physiotherapist / Paramedics
• Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus) OR Entry Level
• Physically fit to carry out duties.
• Certified Medical Coder [Preferable]
• Legally permitted to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
• Certified Medical Coder is preferable, with familiarity in AI-driven coding tools being beneficial
• Experience with AI tools and platforms relevant to claims processing and administration, enhancing operational efficiency and accuracy.