The job holder will be accountable for processing medical claims in line with policy guidelines and agreed turnaround time.

Key responsibilities are as follows;

• Maintain TAT and quality standards for Network claims processing 
• Send electronic bordereau of the E- claims to the payers in order to inform them of approved claims and settlement amounts 
• Prepare weekly and monthly processing reports for internal and external usage of information 
• Answer provider/ insured members / PICs queries relating to claims processing, coverage limit inquires as and when required 
• Review and audit the Network claims processed in line with auditing guidelines and introduce innovative ways to minimize errors 
• Analyse medical trends / utilization rates and detect any fraud and abuse cases

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