Executive Officer - Health Claims Evaluator

EFU Life Assurance Ltd. seeks an Executive Officer - Health Claims Evaluator with a strong background in health claims and medical billing. The ideal candidate will have 1 to 3 years of experience, a Pharm-D qualification is preferred, and a solid grasp of medical terminology and insurance policies. This role involves evaluating health claims to ensure accuracy and regulatory compliance, utilizing claims management software effectively, and supporting efficient claims processing within the organization. Strong communication and analytical skills are essential to manage claims accurately and resolve any discrepancies promptly. The Executive Officer works independently without team management responsibilities but plays a crucial role in ensuring that health claims meet all necessary standards and guidelines. Attention to detail and time management skills are vital for handling multiple claims simultaneously and prioritizing tasks in a fast-paced environment. This position supports EFU Life Assurance Ltd.'s commitment to delivering high-quality service and maintaining compliance with insurance regulations, contributing to the organization's overall success.
Responsibilities
 

• Review and evaluate health insurance claims for accuracy and completeness according to company policies and regulatory requirements.
• Process claims using specialized claims management software to ensure swift and accurate handling of claims.
• Verify medical documentation and billing codes to confirm consistency with the insurance policy coverage.
• Apply knowledge of medical terminology and insurance policies to assess claims and identify discrepancies or potential fraud.
• Communicate effectively with internal departments, healthcare providers, and clients to clarify claims information and resolve any issues.
• Ensure compliance with relevant regulations and company procedures during the claims evaluation process.
• Manage time efficiently to handle multiple claims simultaneously and meet deadlines without sacrificing accuracy.
• Analyze claim data and prepare reports to support decision-making and identify trends or areas for improvement.
• Participate in training sessions and stay updated on changes in insurance laws, policies, and claims processing technology.
• Support audit processes by providing necessary documentation and explanations related to claim evaluations.