Claims Operations Executive at Reliance HMO

Description

This role is responsible for supervising and managing the manual claims and tariff processing team to ensure the claims submitted by our providers are processed and paid promptly and efficiently, and they are error and fraud-free.

Responsibilities:

• Provide supervisory and technical support to the manual claim operations team
• Receive and review approved claims from claims operation associates for final approval and payment
• Investigate complicated claims and pass resolutions based on company policy and clinical standards of care
• Distribute operational tasks across the team to meet objectives
• Quality assurance for claims management
• Oversee the hiring and training of claims operation associates
• Work with technology team on any update on the processes or products for claims and provider management
• Audit and update the standard procedure for claims management and other related SOPs for improved performance
• Provide the divisional lead with regular updates on manual claims operations
• Process healthcare providers’ claims using the claims management process standard procedure
• Participate in provider reconciliation and complaint resolution

Requirements

• Minimum of a first degree in medicine, nursing, or pharmacy
• At least three years of experience in a claim examiner/assessor role
• Excellent numeracy, analytical and problem-solving skills
• Strong medical and clinical knowledge and experience
• Excellent interpersonal and communication skills
• Leadership and management skills