Medical Claims Assessor at Jubilee Insurance

About the Role

We are expanding our dynamic team and seeking talented professionals to join us as Medical Claims Assessors. In this role, you will play a crucial part in ensuring accurate and efficient claims processing while maintaining the highest standards of compliance and customer service.

Key Responsibilities

Operational

• Review and assess medical claims for accuracy, completeness, and eligibility based on policy terms, medical guidelines, and coding systems
• Apply comprehensive knowledge of medical terminology, diagnoses, procedures, and coding systems (e.g., ICD-10, CPT) to determine the validity of claims
• Analyse medical records, invoices, and other relevant documentation to assess the appropriateness of reimbursement
• Communicate effectively with healthcare providers, policyholders, and internal teams to gather additional information or clarify claim details
• Adhere to predefined timelines and service level agreements for claims assessment and resolution
• Maintain accurate records of claims processing activities and ensure confidentiality of sensitive information
• Collaborate with internal teams, such as underwriting, finance, and customer service, to address claim-related queries and resolve issues
• Participate in training programs to enhance knowledge of medical coding practices, industry regulations, and company policies

Corporate Governance & Compliance

• Ensure compliance with company policies, procedures, and regulatory guidelines throughout the claims assessment process
• Maintain confidentiality and handle sensitive information in accordance with privacy laws and regulations
• Adhere to ethical standards and conduct while dealing with confidential or sensitive matters
• Stay informed about applicable laws and regulations relevant to claims assessment

Professional Development

• Engage in ongoing professional development activities to enhance knowledge and skills in claims assessment, regulatory compliance, and corporate governance
• Foster effective working relationships with internal stakeholders, such as underwriting, finance, and reconciliations teams to ensure alignment and collaboration in claims activities