To evaluate medical claims submitted to the company and determine whether claims meet eligibility standard of the company. You will also reconcile provider statements and schedule their payments.
Principal Accountabilities
Claims Processing and Provider Reconciliation
Receiving invoices from various service providers and registering them into the system.
Verifying and auditing all medical claims to ensure supporting documents are attached and following up on documents not submitted with service providers/clients.
Accurate capturing of all invoices in the system.
Prompt account reconciliation and sign-offs with service providers and address all disputes to completion.
Recommend appropriate payment of disputed billing as necessary.
Negotiate and schedule monthly medical payments for approval.
Prepare and send payment remittances.
Prepare monthly claims, reconciliation, and sign-off reports for management.
Customer Service
Respond to client queries on telephone, calls, emails, and walk-in clients.
Build and enhance relationships with providers to ensure the PACIS Insurance account with the providers is current and active.
Ensure adherence to contracts and service level agreements (SLAs) between providers and the company.
Qualifications and Requirements
Academic Qualification
Degree in a Business-related course, Statistics, or Accounts.
Professional Qualifications
Diploma in Insurance (IIK) is an added advantage.
Experience
1 year experience in the claims section of a health insurance department.
Knowledge
Strong understanding of the insurance industry.
How to Apply
Interested and qualified candidates should apply online via the provided application link or through the PACIS Insurance website.
How to Apply
Interested and qualified candidates should apply online through the PACIS Insurance application portal: Apply Now. Alternatively, you can visit the company website at www.pacisinsurance.com.
