Senior Claims Officer- Pharmtech at Barclays Bank

To support the Head of Medical Claims in the Medical Department by providing operational support in the Medical Department processes. To process and settle insurance claims in a fast, fair and courteous manner to ensure customer satisfaction, company profitability and good corporate image

Key Responsibilities.

• Claims vetting and approval (90%)
  
  • Receiving and registering incoming claims
  • Claims adjudication
  • Analysing all patients’ claims (In terms of completeness and validity) and processing them for payment
  • Examining and confirming member benefits, entitlements and exclusions
  • Preparing member statements (on request) for clients regarding their policy benefit utilisation status
  • Preparing payment remittances and credit notes where applicable
  • Liaising with providers where there queries on the claims submitted
• Customer service, provider negotiations and reconciliation (10%)
  
  • Handling customer queries (walk-in, phone & e-mail) in regards to claims and payments
  • Assist in reconciliation and attending reconciliation meetings with the providers
  • Review of provider’s charges and negotiating for better rates