Claims Officer

Qualifications & Requirements Applicants must meet the following requirements: Diploma or Degree in Clinical Medicine, Business Administration, Health Records, Finance, or any other relevant business/health-related field Minimum of three (3) years’ relevant experience in a busy private hospital setting Strong and proven knowledge of SHA (Social Health Authority) claims processes and other private insurance schemes Good understanding of hospital billing, pre-authorizations, claim submissions, and reconciliation processes Experience in handling claim rejections, resubmissions, and follow-ups with insurers Familiarity with hospital management systems and electronic claims processing will be an added advantage Strong analytical, numerical, and documentation skills High level of accuracy, integrity, and attention to detail Excellent communication and follow-up skills with insurers and internal hospital departments Ability to work effectively under pressure in a fast-paced environment with strict deadlines Key Responsibilities The successful candidates will be expected to: Process and submit insurance claims accurately and in a timely manner in line with SHA and private insurer requirements Review patient documentation to ensure completeness and compliance before claim submission Follow up on pending, rejected, or queried claims with insurance providers Conduct claim reconciliation and assist in resolving variances between billed and paid amounts Ensure proper coding and documentation support for all submitted claims Collaborate closely with clinicians, billing, and finance teams to ensure accurate claim preparation Maintain organized records of all claims submitted, paid, pending, or rejected Support pre-authorization processes and verification of patient eligibility where required Monitor claim performance and provide regular reports on claim status and trends Ensure compliance with insurance policies, hospital procedures, and regulatory requirements go to method of application »