Role Summary:

Responsible for accurate assessment, processing, and settlement of medical insurance claims in line with company policies and service standards.

Key Responsibilities:

• Receive, register, and analyze medical claims
• Verify completeness and authenticity of claim documents
• Assess claims against policy terms and recommend approval or rejection
• Process fully documented claims within set timelines
• Identify and escalate suspicious or fraudulent claims
• Initiate reinsurance and third-party recoveries
• Review and update claims reserves based on new developments
• Handle customer queries and provide guidance on claims procedures
• Liaise with service providers, clients, and internal teams on claim issues
• Maintain accurate records and documentation of claims
• Prepare claims analysis reports for management

Skills & Competencies:

• Strong analytical and problem-solving skills
• Attention to detail and accuracy
• Good communication and interpersonal skills
• Customer service orientation
• High integrity and professionalism

Qualifications:

• Bachelor’s Degree in a health-related or business-related field
• Professional insurance qualification is an added advantage

Experience:

• Minimum 2–3 years’ experience in claims processing or insurance environment

• Receive, register, and analyze medical claims
• Verify completeness and authenticity of claim documents
• Assess claims against policy terms and recommend approval or rejection
• Process fully documented claims within set timelines
• Identify and escalate suspicious or fraudulent claims
• Initiate reinsurance and third-party recoveries
• Review and update claims reserves based on new developments
• Handle customer queries and provide guidance on claims procedures
• Liaise with service providers, clients, and internal teams on claim issues
• Maintain accurate records and documentation of claims
• Prepare claims analysis reports for management

• Strong analytical and problem-solving skills
• Attention to detail and accuracy
• Good communication and interpersonal skills
• Customer service orientation
• High integrity and professionalism

• Bachelor’s Degree in a health-related or business-related field
• Professional insurance qualification is an added advantage