Medical Claims Officer

Job Description

The Medical Claims Officer is responsible for handling and processing medical and employee benefit claims, ensuring accurate documentation, timely follow-up, and excellent client service. The role acts as a key liaison between clients, hospitals, TPAs, and insurance companies to ensure smooth claim settlement and resolution.

Key Responsibilities

Review and process medical, life, and workmen compensation claims.
Serve as the main point of contact for clients and insurance providers regarding claims and coverage inquiries.
Follow up on pending claims to ensure timely settlement and reimbursement.
Provide clients with clear information on coverage, deductibles, copayments, and claim procedures.
Prepare and maintain accurate claims records, reports, and documentation.
Coordinate renewals, additions, deletions, and other policy updates.
Ensure high levels of customer satisfaction through prompt and professional communication.

Requirements

Bachelor’s degree in Business Administration, Insurance, or a related field.
0-2 years of experience in medical claims or insurance.
Strong attention to detail and organizational skills.
Good communication and client servicing abilities.
Proficiency in MS Office (Excel is a plus).

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