Officer Network Claims

As a member of Munich Re, the MedNet Group is a leading Third-Party Administrator across the MEA region. We are currently seeking to hire an Officer Network Claims. The job holder's responsibilities are: Adjudicate, Process & Audit Network / Reimbursement outpatient & inpatient claims.

Your Role:

• Manage daily claims administration work of review and processing of claims in line with scope of coverage and provider contracts.
• Audit claims data to identify any fraud, waste, and abuse activities.
• Ensure accuracy and consistency of data.
• Forward approved claims once processed to PICs (Preferred Insurance Companies) for their acknowledgment or approval as per thresholds.
• Review and respond to claims audits of clients and internal audits.
• Answer provider, insured members, and PICs queries accurately via phone calls and emails, regarding claims processing to provide clarifications where needed.
• Work with high efficiency, minimizing errors and administration time to achieve monthly deadlines and defined SOPs.
• Enter data accurately to provide accurate records to the company and PICs.
• Respond to external inquiries politely and professionally.

Your Profile:

• Diploma in Nursing, Physiotherapy, and Pharmaceutical Sciences.
• Coding certifications are an added advantage.
• Microsoft Access database and Power BI programming skills are an added advantage.
• 2-3 years of experience in claims in the insurance industry or TPA/MSO Company.
• Excellent interpersonal and communication skills with a very good command of English.
• Working on split or straight shifts according to business needs.
• Ability to communicate sensitively and effectively with internal and external stakeholders having regard for the strict need for confidentiality.
• Advanced knowledge of Microsoft packages (Word, PowerPoint, and Excel), email, electronic calendar, and the Internet.

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.