Group Health Claim Officer

Key Responsibilities:

• Review and analyze health insurance claims to ensure completeness, accuracy, and compliance with policy terms and company guidelines.

• Process, assess, approve, decline, and submit claim payments in accordance with established SLAs and policy provisions.

• Prepare accurate and timely claim reports, conduct data analysis, and provide insights to support operational performance.

• Monitor and evaluate vendor payment processes to ensure accuracy, completeness, and timely settlement.

• Ensure all claim handling activities comply with internal procedures, service standards, and business objectives.

• Collaborate with internal teams and external stakeholders to maintain effective claim operations and deliver excellent service to corporate clients.

Requirements:

• Bachelor’s degree in a health-related field, such as Medicine, Public Health, Nursing, Pharmacy, or a related discipline.

• Minimum 2 years of experience in Group Health Claims within the health insurance or Third-Party Administrator (TPA) industry.

• Good understanding of health insurance claim processes, policy administration, and claim assessment.

• Strong analytical skills, attention to detail, and problem-solving abilities.

• Ability to work effectively in a fast-paced environment, manage priorities, and meet established service targets.

• Strong communication skills and a commitment to delivering high-quality service.