Officer - Claims at Munich Re

Suomussalmi, Kainuu, Finland -

Full Time

Start Date

Immediate

Expiry Date

28 Jun, 26

Salary

0.0

Posted On

30 Mar, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Claims Processing, Claims Evaluation, Medical Audit, Data Entry, Medical Terminology, Interpersonal Skills, Negotiation Skills, Communication Skills, Analytical Thinking

Industry

Insurance

Description

MedNet Jordan is one of the leading managed care service organizations that caters to healthcare needs. We are currently seeking to hire an Officer – Claims (on Hybrid working modules basis) with the following tasks and responsibilities: Your Job Medical Claims Processing Applying Claims Department Policy, Procedures and quality measures for processing claims. Processing Claims efficiently & accurately, according to FIFO (First In First Out) of providers network claims along with international claims through network providers. Process the EPD (Early Payment Discount) batches according to priorities as per assignment from Claims Team Leader. Entering data accurately in order to provide accurate records to the company and Participated Insurance Companies (PICs). Work in high speed and efficiency to achieve monthly targets. Medical Claims Evaluation: · Authorization for in and out-hospital cases in respect of medical necessity and appropriateness. · Evaluation & approval of outpatient & Inpatient claims need authorization in respect to the medical necessity and appropriateness and check them in the system to ensure high quality and correct services. · Chronic soap evaluation, issue, checking, sign & stamp. Quality & Audit of Claims Processed Conduct Medical Audit and review sample of Processed Claims – sample defined as per confidence level target set on a yearly basis - against scope of coverage and provider contracts as set in Claims Best Practice Manual. Checking batch list for printed out bordereau when required ahead of bordereau issuance. Your Profile Bachelor degree in Nursing, pharmacy or physician. 1-3 years of experience in medical field. Experience in insurance industry or TPA is a plus Computer literacy ( MS Office, Excel, PowerPoint) Knowledge related to medical terminology Good Command in English language. Industry knowledge related to local health services system is a plus. Team Player Eager to learn and seek for knowledge. Good interpersonal and negotiation skills Excellent written and verbal communication skills. Analytical Thinking

Responsibilities

The role involves processing medical claims efficiently and accurately according to policy, including handling network and international claims, and evaluating authorizations for in-hospital and outpatient cases based on medical necessity. Responsibilities also include conducting medical audits on processed claims against coverage scope and provider contracts.