Assistant Executive – Medical Claims

Job Overview: - We are looking for an experienced, technically competent and customer-focused professional to join our Claims Department as Assistant Executive – Medical Claims. Key Responsibilities: - Receive and review health insurance claims submitted by policyholders or healthcare providers. - Identify documentation gaps or discrepancies and coordinate with senior team members. - Ensure all required documentation is complete and compliant. - Enter relevant information from claims documents into the claims processing system. - Verify and update policyholder information. - Perform detailed verification of medical documents and service provider credentials. - Validate claims against policy coverage and identify irregularities. - Communicate with policyholders and healthcare providers for additional information on claims. - Assist in preparing claims files for review. - Maintain organized records of claims processing activities. - Address inquiries from policyholders and healthcare providers. - Participate in quality assurance activities and recommend improvements. - Collaborate with team members to ensure efficient claims processing.