Medical Officer

Roles and Responsibilities

The Medical Claims Officer will provide quality service to clients, promptly and effectively assess and process claims and approvals according to operations set standards.

MAIN TASKS

1. Manages routine daily claims administration work.
2. Coordinates work flow & meets deadlines.
3. Evaluates claims with regards to eligibility.
4. Takes decisions on high cost and complicated cases based on standard operating procedures.
5. Handles International Preauthorization cases as required.
6. Attends calls and e-mails from insurance companies, clients, and providers.
7. Coordinates with international providers for direct billing.
8. Makes suggestions to improve service.
9. Increases efficiency, minimizes errors and administration time.

BEHAVIORAL REQUIREMENTS

1. Organizational & time management skills.
2. Excellent team player.
3. Ability to work well with all levels of internal management and staff, as well as outside clients and users.
4. Ability to demonstrate sound work ethics.
5. Show flexibility with excellent interpersonal skills.
6. The ability to communicate sensitively and effectively with claims department and other departments having regard for the strict need for confidentiality.
7. To be capable of responding diplomatically to pressures and problems showing a calm approach to working towards deadlines and always able to show an innovative and creative approach to work.
8. The ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.
9. Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others.

BEHAVIORAL COMPETENCY

Customer & Market Excellence:

1. Strive for excellence at every touch point with the customer.
2. Foster state-of-art technical/operational knowledge and strive for continuous simplification.
3. Be the benchmark.

Desired Candidate Profile

Collaborative Leadership:

1. Empower the team and provide purpose and direction.
2. Develop people, provide feedback and care to employee wellbeing.
3. Collaborate and exchange best practices.

Entrepreneurship:

1. Act on opportunities, anticipate trends, take risks, and promote a culture that allows for honest failure.
2. Take ownership and responsibility.
3. Embrace innovation and a culture that allows making decisions without fear of retribution.

Trust:

1. Act with integrity, honor commitments, tell the truth.
2. Foster diversity and inclusiveness.
3. Act transparently and promote corporate social responsibility.

MINIMUM REQUIREMENTS

1. Bachelor’s of Medicine (MBBS) only.
2. Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).
3. Physically fit to carry out duties.
4. Legally permitted to work in the country of operations.
5. Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.