Role Overview

The Medical Claims Excellence Advisor is responsible for daily claim processing and evaluating medical insurance claims to ensure accuracy, compliance, and timely resolution. The role involves reviewing documentation, verifying coverage, and communicating with seniors to facilitate smooth claim processing.

Key Responsibilities

Assess medical claims in compliance with the terms and conditions of the policy.

Verify medical codes, diagnoses, and procedures to ensure compliance with industry standards (e.g. ICD-9, ICD-10, CPT).

Escalate enquiries and complex cases to Seniors when necessary in line with internal guidelines.

Process claim payments in accordance with the company’s objectives and guidelines.

Prepare claim communication letters.

Stakeholder Management

Internal Communication:

Requirements

• 1-3 years of experience in medi...