Senior Officer - Claims Processor

EFU Life Assurance Ltd. is seeking a diligent Senior Officer specializing in Claims Processing to join our team. The ideal candidate will have a graduation degree and between one to two years of experience in health claim processing. This role requires hands-on expertise in managing claims from initiation through verification and final settlement, working closely with various departments to ensure accurate and timely processing. The position demands a strong understanding of health insurance policies, medical terminology, and the Reasonable and Customary charges applicable to claims. Proficiency in MS Office is essential to handle documentation and reporting efficiently. Attention to detail, excellent coordination skills, and a customer-oriented approach are critical to succeed in this role. The position does not involve managing a team but requires effective collaboration with different stakeholders to support smooth claims operations.

Responsibilities

• Process health insurance claims by reviewing documentation and verifying accuracy in accordance with policy terms and regulatory guidelines.
• Evaluate claims for eligibility, medical necessity, and compliance with Reasonable and Customary charges before processing.
• Maintain and manage detailed documentation related to claims throughout their lifecycle to ensure completeness and audit readiness.
• Coordinate with healthcare providers, customers, and internal departments to resolve discrepancies and gather additional information as required.
• Utilize MS Office tools to create reports, track claim statuses, and manage correspondence efficiently.
• Apply knowledge of medical terminology to interpret clinical notes and supporting documents for accurate claim validation.
• Ensure adherence to company policies and industry regulations while processing claims, minimizing errors and fraud risks.
• Provide responsive and professional customer service by addressing inquiries and offering clear explanations about claims status and procedures.
• Collaborate with cross-functional teams to improve claims processing workflows and contribute to the development of best practices.
• Monitor and report on claim processing metrics to identify trends and recommend improvements to management.