About the Role
Reimbursement Officer
Key responsibilities/What you do:
- Evaluate and approve medical requests in line with policy guidelines.
- Verify the necessity of treatment plans for patients.
- Regularly enter verbal and written claims approvals.
- Make approval decisions based on policy terms.
- Review and decide on high-cost and complex claims.
- Provide clear, detailed feedback to the Call Centre team’s inquiries.
- Explain reasons for declined medical claims to clients.
- Manage workflow efficiently to meet deadlines.
- Assess claims for eligibility criteria
Key requirements/What you bring:
- Bachelor’s degree in Medicine, Pharmacy, or Dentistry.
- Minimum of 2 years practical medical experience (experience with reputable insurance providers, brokers, or TPAs is advantageous).
- Legal authorization to work in the op...
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