Claims Officer (Physician Assistant)

  • Greater Accra
  • Permanent
  • Full-time
  • 16 days ago
  • Apply easily
Our client is seeking to hire an experienced individual with deep industry knowledge in the health insurance field to handle insurance claims for the client in the capacity of a CLAIMS OFFICER.ROLE PROFILEThe ideal candidate will be ensuring the smooth and efficient processing of insurance claims while maintaining high standards of accuracy, compliance, and customer satisfaction. He or she will perform the following duties as well:DUTIES/RESPONSIBILITIES:
  • Examine submitted claims for completeness, accuracy, and compliance with policy terms
  • Verify the eligibility of policyholders and beneficiaries
  • Determine coverage based on policy provisions and medical necessity
  • Make decisions on claim approvals or denials
  • Calculate and authorize payments for approved claims
  • Identify and address discrepancies or inconsistencies in claim information
  • Respond to inquiries from policyholders, healthcare providers, and internal departments
  • Coordinate with medical professionals or external reviewers to obtain additional information or clarification
  • Liaise with other departments such as underwriting and customer service as needed
  • Identify and investigate potential fraudulent claims
  • Implement preventive measures to detect and reduce fraudulent activity
  • Ensure adherence to all relevant laws, regulations, and internal policies
  • Maintain accurate and up-to-date records and documentation

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