Claims Officer

The Claims Officer will be responsible for managing the hospital’s insurance and corporate claims processes, ensuring accurate claims preparation, timely submission, proper reconciliation, and maximization of revenue collection in compliance with insurer and regulatory requirements.

Key Responsibilities:

1. Prepare, verify, and submit insurance claims (SHA and private insurers) accurately and within stipulated timelines.
2. Review patient files to ensure completeness of documentation before claim submission.
3. Reconcile claims submitted against payments received and identify variances.
4. Follow up on pending, rejected, or partially paid claims to ensure timely reimbursement.
5. Analyze claim rejection trends and recommend corrective measures.
6. Liaise with insurers, corporate clients, and internal departments to resolve claim-related discrepancies.
7. Maintain accurate claims records and update tracking systems regularly.
8. Ensure compliance with insurer contracts, pre-authorization requirements, and billing guidelines.
9. Support revenue cycle management by coordinating with billing, pharmacy, laboratory, and clinical departments.
10. Generate periodic claims performance reports (submission rates, rejection rates, aging analysis).
11. Assist in preparing documentation required for insurer audits and reconciliation meetings.
12. Monitor credit control and aging of receivables from insurance and corporate accounts.
13. Ensure confidentiality and secure handling of patient financial data.
14. Participate in continuous improvement initiatives to strengthen claims management processes.

Job Qualifications & Skills

1. Diploma in Accounting, Finance, or a related business field.
2. Minimum of 2 years’ experience in hospital billing or insurance claims management.
3. Strong understanding of healthcare billing systems and claim processing procedures.
4. Knowledge of SHA and private insurance claim guidelines.
5. Proficiency in Microsoft Excel and hospital management systems.
6. Strong analytical and reconciliation skills.
7. High level of accuracy and attention to detail.
8. Good negotiation and follow-up skills.
9. Strong communication and interpersonal skills.
10. Ability to work under pressure and meet strict submission deadlines.