Claims Processing Agent

About the role

We are seeking a Claims Officer to deliver quality service to clients by promptly assessing and processing medical claims in line with operational standards. The role also contributes to team success by setting and monitoring individual and collective objectives while ensuring adherence to company policies.

Key responsibilities

• Evaluate medical claims from technical and medical perspectives according to policy terms.
• Guide colleagues in handling complex medical cases to improve quality and output.
• Verify the necessity of specific treatment plans for patients.
• Analyze patterns of abuse, fraud, waste, and trends in claim data.
• Provide second‑opinion referrals when treatment plans are doubtful.
• Maintain daily productivity targets, service levels, and coordinate workflow to meet deadlines.

Required profile

• Bachelor’s degree in Medicine (MBBS), Dentistry (BDS), Pharmacy, or Nursing.
• Minimum 2 years of practical experience in medical insurance, brokerage, or TPA environments.
• Physically fit and legally authorized to work in the country of operation.
• Proficient in MS Office (Excel, Word, Outlook, PowerPoint) and skilled in internet research.

Required skills

• MS Office suite (Excel, Word, Outlook, PowerPoint).
• Internet navigation and research.