Claims Officer at Ciala Hospital

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