Claim Processing Officer
SGMC
Employer Active
Posted 8 hrs ago
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Experience
1 - 7 Years
Education
Bachelor of Business Administration(Management)
Nationality
Any Nationality
Gender
Not Mentioned
Vacancy
1 Vacancy
Job Description
Roles & Responsibilities
Job. Overview:
Seeking a detail-oriented Claim Processing Officer to review, verify and process insurance or medical claims efficiently and accurately. The role involves communication with clients, healthcare providers and internal departments to resolve discrepancies and ensure timely claim settlements.
Key Responsibilities:
- Review, verify, and process medical claims in compliance with insurance policies and hospital guidelines.
- Coordinate with insurance companies/TPAs regarding pending, delayed claims.
- Ensure accurate documentation and timely submission of claims.
- Reconcile claim payments, resolve discrepancies, and follow up on outstanding balances.
- Communicate with internal departments (billing, accounting, medical staff) to resolve claim issues.
- Track claim statuses and maintain updated records in the hospital system.
- Investigate and escalate long-pending or disputed claims when necessary.
- Prepare and share regular reports on claim status, collections, and outstanding amounts.
- Assist in audits and compliance reviews related to claims and billing.
- Support process improvements to enhance efficiency and reduce claim discrepancies.
Desired Candidate Profile
Job Requirements:
Education & Experience:
- Bachelor s degree in Business Administration, Accounting, Healthcare Management, or related field.
- Previous experience in claims processing, billing, or healthcare insurance is preferred.
Skills:
- Strong attention to detail and analytical skills.
- Good knowledge of insurance policies, claims procedures, and billing systems.
- Excellent communication and follow-up skills.
- Proficiency in MS Office (Excel, Word).
Company Industry
- Medical
- Healthcare
- Diagnostics
- Medical Devices
Department / Functional Area
- Insurance
- Underwriting
- Surveying
- Actuary
Keywords
- Claim Processing Officer
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SGMC
Saint George Medical Center is committed to providing high-quality healthcare to the community in an environment of compassion, equity, and continuous development. It aims to be a leading, academically-driven healthcare facility delivering comprehensive, individual-centered care. SGMC is currently recruiting a Claim Processing Officer