Executive Officer- Claims Processor

Job Description

The Executive Officer will be responsible for registering and processing health insurance claims accurately, verifying completeness of claims documentation, and conducting preliminary policy checks to uphold company standards. Additionally, the candidate will manage claims throughout their lifecycle, update system data based on evaluation decisions, and evaluate Reasonable and Customary charges for out-of-network providers while ensuring alignment with network rates. Collaboration with the Finance Department to guarantee timely and precise claim payments is essential. The incumbent will comply with internal procedures, policy terms, regulatory guidelines, and defined turnaround times to enhance customer satisfaction and operational efficiency.
Responsibilities
 

• Register and accurately process health insurance claims using the companys claims management system or ERP.
• Verify the completeness and correctness of claim documents and perform initial policy and coverage checks before further processing.
• Coordinate the forwarding of claims for evaluation and diligently track each claim through its lifecycle to ensure timely resolution.
• Update claims data in the system according to approved evaluation decisions to maintain precise and current records.
• Review Reasonable and Customary charges for non-network hospitals and compare these charges with network hospital rates to identify discrepancies.
• Close claims accurately in the system after approval and prepare necessary documents such as Form-D for payment processing.
• Work closely with the Finance Department to ensure timely and accurate disbursement of claim payments to customers and service providers.
• Ensure all claims processing activities comply with company policy terms, internal protocols, regulatory standards, and defined turnaround times (TATs).
• Maintain proficiency in MS Office applications and health insurance systems to streamline claims processing tasks.
• Stay informed about current health insurance policies, medical terminologies, hospital billing procedures, and claims-related best practices.
• Assist in identifying areas for process improvement to enhance the efficiency and accuracy of claims management operations.
• Provide documentation and support during audits or regulatory reviews related to claims processing activities.
• Maintain confidentiality and security of sensitive claim information in compliance with regulatory and company data protection policies.

Job Skills

Claims ManagementInsurance PoliciesClaims InvestigationInsurance claims management

Job Details

Total Positions:

1 Post

Job Type:

Full Time/Permanent

Job Location:

Karachi, Pakistan

Gender

No Preference

Minimum Experience

2 Years

Apply Before:

Jun 03, 2026