Job Description

• Apply medical knowledge and best insurance practice while auditing / reviewing the claims prior submission, medical records and other documentation essential to justify the services rendered to the patient by the healthcare facility.
• Ensure that the details of the claims are in line with the regulators' standards especially the claim adjudication Rules and Business Rules.
• Handling resubmission of rejected claims.


• Review and Audit Medical Claims to ensure their accuracy.
• Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
• Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
• Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
• Submit the claims with proper codes and format to insurance companies within the stipulated time
• Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.
• Comply with all OSH and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements
• Work accordance with the documented OSH procedures and instructions, specific responsibilities
• Be familiar with emergency and evacuation procedures
• Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports
• Comply with Waste management procedures and policies
• Attend applicable OSH/Infection control training programs, mock drills and awareness programs
• Use of appropriate personal protective equipment and safety systems


• Medical/paramedical (Nursing, pharmacy, etc.) graduate from a recognized university.
• Experience in Insurance Claims management/adjudication (minimum 2 years)
• Experience in Medical Coding is preferable.
• Excellent command of oral and written English.