Claims Officer
Job Summary
- Job Location: North Ridge, Accra, , GH
- Job Function: Accounting, Auditing & Finance
- Employment Type: Full-Time
- Minimum Experience: 2 years
- Minimum Qualification: First Degree
- Age Range:
- Preferred Gender: Any
- Salary:
Job Description
Technical Requirements
* Examine submitted claims for completeness, accuracy, and compliance with insurance policy terms
* Identify and address any discrepancies or inconsistencies in claim information
* Respond to inquiries from policyholders, healthcare providers, and internal departments regarding claims
* Implement measures to prevent and detect fraudulent activities
* Ensure compliance with all applicable laws, regulations, and company policies related to claims processing
* Determine coverage based on policy provisions and medical necessity
* Identify and address any discrepancies or inconsistencies in claim information
* Coordinate with medical professionals or external reviewers to obtain additional information or clarification
* Identify and investigate potential fraudulent claims
* Liaise with other departments within the insurance company, such as underwriting or customer service, as needed
Experience and Qualifications
* Minimum of a bachelors degree in a medical or a related field from an authorized university
* At least one year working experience in a health insurance company
* A degree in Physician Assistant Studies will be an added advantage
* Strong analytical and problem-solving skills
* Attention to detail and accuracy
* Excellent communication and interpersonal skills
* Knowledge of healthcare terminology and medical procedures
* Proficiency in using claims processing software and systems
* Understanding of insurance principles and regulations