Insurance Claims Processor

JOB DESCRIPTION
Designation : Insurance Claims Processor
Section/Department : Insurance/ Finance
Reporting to : Insurance Claims Supervisor
Responsible for/Reporting Staff :
Purpose and Scope of the Job:
Obtain information from insured or designated persons for purpose of settling
claim with insurance carrier. Completing insurance claim forms, preparation of
the claim and performing related work as required.

Main Duties and Responsibilities/Performance Standards
* Receives the Insurance claims & related documents from the reception or billing clerk and any other concern staff or section.
* Checks the documents and registering the status in the excel file or in the sap system.
* Verifies the documents, coverage, exclusions and deductibles.
* Verifies the required information of the documents and if missing returning to the concerned for correction.
* Contacts receptionist or other involved persons to obtain missing information.
* Prepares the report of the errors
* Answers questions regarding insurance claims, missing documents, error corrections status.
* Daily posting and updating of the receiving, missing and error status in the system
* Sorts, separates and attaches the claims as per company and policy holders
* Prepares and reviews insurance-claim forms and related documents for completeness.
* Participates in the departmental meetings, trainings and educational programs
* Prepares the monthly statement for submission according to the requirement of the insurance co. and corporate.
* Performs the duty as per the assigned weekly, fortnightly and monthly scheduled, shifts and timings by the supervisors or department.
* Ensures the timely Submission of claims to internal section and to the insurance company as per assigned schedule and target dates.
* Adheres to established departmental policies s and procedures.
* Maintains departmental records and files, and takes care of departmental equipment.
* Participates in the planning, organizing and development for the achievement of the departmental goals.
* Performs miscellaneous job-related duties as assigned.
* Ensures quality and patient safety practices are followed (occupational and patient safety).
* Provides and promotes people centered care.
* Promotes inclusive health by providing equitable and accessible care to patients and families with special needs.

Qualifications, Competences and Skills
Education : Bachelor's Degree / Diploma
Experience: At least ‎2-‎3 years of experience directly related to the
duties and responsibilities specified.
Licensure : Not Applicable
Language : Well versed in English languages - to read and to write, Arabic
is an advantage.
Computer Proficiency : Computer literacy - highly skilled in the use of
spreadsheets and word processing packages.

Performance Competencies
* Knowledge of basic medical insurance claim forms and procedures.
* Knowledge of simple posting methods and computer terminal operations.
* Ability to understand and complete insurance claim forms.
* Ability to post claims and payments.
* Ability to understand basic medical insurance policies.
* Ability to answer questions regarding claims, coverage and payments.
* Ability to establish and maintain an effective working relationship with the public and other employees.
* Ability to work independently on a variety of responsible clerical tasks.
* Ability to calculate numbers, correct entries, and post to records.
* Ability to analyze and solve problems.
* Ability to communicate effectively, both orally and in writing.

Principle Working Relationships and Remarks
* Finance & Reception Staff
* Insurance Companies
* Patients laiming insurance