At Ciala Hospital, we are committed to providing exceptional healthcare services to our patients with compassion, expertise, and the latest medical advancements. With a team of dedicated professionals and state-of-the-art facilities, we strive to be a leading healthcare provider in our community.
Qualifications & Requirements
- Diploma or Degree in Clinical Medicine, Business Administration, Health Records, Finance, or any other relevant business/health-related field
- Minimum of three (3) years’ relevant experience in a busy private hospital setting
- Strong and proven knowledge of SHA (Social Health Authority) claims processes and other private insurance schemes
- Good understanding of hospital billing, pre-authorizations, claim submissions, and reconciliation processes
- Experience in handling claim rejections, resubmissions, and follow-ups with insurers
- Familiarity with hospital management systems and electronic claims processing will be an added advantage
- Strong analytical, numerical, and documentation skills
- High level of accuracy, integrity, and attention to detail
- Excellent communication and follow-up skills with insurers and internal hospital departments
- Ability to work effectively under pressure in a fast-paced environment with strict deadlines
Key Responsibilities
- Process and submit insurance claims accurately and in a timely manner in line with SHA and private insurer requirements
- Review patient documentation to ensure completeness and compliance before claim submission
- Follow up on pending, rejected, or queried claims with insurance providers
- Conduct claim reconciliation and assist in resolving variances between billed and paid amounts
- Ensure proper coding and documentation support for all submitted claims
- Collaborate closely with clinicians, billing, and finance teams to ensure accurate claim preparation
- Maintain organized records of all claims submitted, paid, pending, or rejected
- Support pre-authorization processes and verification of patient eligibility where required
- Monitor claim performance and provide regular reports on claim status and trends
- Ensure compliance with insurance policies, hospital procedures, and regulatory requirements
