Medical Claims Vetter
Job Description
To process medical claims
with a focus on cost control and management of member benefits through vetting
and coding of inpatient and outpatient bills and capturing in the company
medical business operating system(s).
- Verify, audit, and Vet medical claims for payment for both
outpatient and inpatient claims as per the claim’s manual/Standard
operating procedure.
- Adhere to the customer service charter manual to ensure
compliance with agreed turnaround times
- Prompt reporting of any identified risks during claims
processing for mitigation.
- Monitor, prevent, and control medical claims fraud/wastages
during claims processing.
- Use of data analytics to review cost and quality of service
at medical service providers.
- Hold regular business meetings with service providers to
ensure compliance on systems such as smart card systems and agreed tariffs.
- Evaluate preliminary claim information and revert to broker
or insured for more information where necessary to ensure that the correct
information is documented for ease in processing of member reimbursement
claim
- Respond to client inquiries within 24 hours of inquiry.
- Communicate and liaise with medical service providers on the
resolution of disputed claims.
- Any other duties assigned by management.
Skills
- Medical Claims Vetting, clinical experience
Education
- Bachelor’s degree in any medical-related field, Diploma in
Nursing /Clinical Medicine, or any medical-related field.
How To Apply
Apply before or on 16th
Jan 2024
