Job Description
Medical Claims Officer - Pharmacist only
A Medical Claims Officer delivers high-quality service to clients by promptly and accurately assessing, processing, and approving claims in line with operational standards. A Senior Medical Claims Officer also drives team success by setting, implementing, and monitoring individual and group objectives, ensuring strict compliance with company policies and procedures.
Key responsibilities/What you do:
- Evaluate medical approvals and policy applications.
- Guide Medical Claims Officers in managing complex medical cases, enhancing both quality and productivity.
- Maintain meticulous attention to detail and quality, leveraging AI analytics to ensure consistency and precision.
- Offer second opinions on cases with uncertain treatment plans.
- Review high-cost claims, make informed decisions on complicated cases, and communicate sensitively with the P...