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Non-Medical
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Claims Officer

Job Description and Requirements

Role Purpose

Ensures that claims (bills) for the companies are properly prepared, thoroughly checked and presented in a timely manner.

KEY RESPONSIBILITIES

  1. Receives all OPD and inpatient invoices daily.
  2. Sorts the invoices in the primary classification of the companies, with sub-sorting to the file numbers within the company categories.
  3. Ensures that referral letters, insurance claim forms, all result of investigations, details of inpatient and discharge summary are in proper order, Insurance ID cards are updated.
  4. At the end of the month, or as required for any period, checks the invoices against the computer printout and prepares the claims.
  5. Ensures that the claims are recorded, copies are filed correctly, and arranges for the originals to be sent to the respective companies.
  6. Receives any returns or rejected claims, performs a check analysis and reports on them to the Supervisor for appropriate action.
  7. Fully aware and actively implement the departmental policies and procedures, local and international standards or requirements related to the department.
  8. Actively involves in indicator development, data collection for the department and to measure the performance of the function, process, and outcome.  Whenever required, conducts analysis and interpretation of data/information collected.
  9. Participate in hospital Safety Management & Risk Management Programs. Actively reports incidents in the system and whenever needed, participates in incident review, and root cause analysis.
  10. Performs any other duties within the range of his/her competence, as directed by the Business Center Manager.

JOB SPECIFICATIONS

  • Degree in Accountancy / Commerce Management, or any related course.