Department: Health Insurance/Claims Processing
Reports to: Claims Manager/Claims Head
Location: Islamabad
Salary: 120-140k + other benefits
Job Summary:
We're seeking a Senior Claims Officer to evaluate, verify, and process medical insurance claims. You'll assess documentation, ensure policy compliance, and coordinate with hospitals and internal teams to resolve issues.

Key Responsibilities:

• Review and examine hospital claims for accuracy and validity
• Verify medical records and documents
• Evaluate claims based on medical necessity and policy coverage
• Process eligible claims in a timely manner
• Coordinate with hospitals and internal teams for clarifications and dispute resolution
• Identify and report inconsistencies and potential fraud
• Maintain accurate records and provide inputs for process improvement
• Train junior staff and contribute to knowledge sharing
• Prepare periodic reports on claims processing and exceptions

Qualifications:

• MBBS degree preferred (other medical qualifications or relevant experience considered)
• Minimum 2 years of experience in health insurance claims processing or hospital billing/medical audit

Key Skills:

• Strong medical knowledge and analytical skills
• Good understanding of health insurance policies and claims processes
• Attention to detail and effective communication skills
• Ability to work under pressure and meet deadlines
• Proficient in claims management systems and MS Office tools