Staff - Health Claim Assessor (Pre-arrangement)

Job Descriptions:

• Review and evaluate health claims submitted by policyholders to ensure completeness and accuracy.

• Verify policy coverage and eligibility for claimed services.

• Liaise with healthcare providers and policyholders to gather necessary documentation and information.

• Provide clear communication regarding the claims process, requirements, and timelines.

• Ensure that all claims are processed in accordance with company policies, industry regulations, and best practices.

• Assist in identifying and resolving discrepancies or issues related to claims.

• Work closely with internal teams to facilitate efficient claims processing.

• Participate in team meetings and contribute ideas for improving processes.

• Generate reports on claims processing metrics and key performance indicators as required.

• Identify trends or areas for improvement in the claims process.

Qualifications:

• Bachelor’s degree in nursing

• Experience in Claim Assessor, Concurrent Review, UR Nurse

• Strong attention to detail and analytical skills

• Excellent communication and interpersonal skills

• Proficient in Microsoft Office Suite and claims management software

• Knowledge of health insurance policies and regulations is a plus