Description:

The Medical Claims - Officer will provide quality service to clients, promptly and effectively assesses and process OP claims according to operations set standards

Key responsibilities/What you do:

Manages routine daily claims administration work.
Coordinates work flow & meet deadlines.
Evaluates OP claims with regards to eligibility.
Apply nextcare cost containment protocols for OP claims at the retrospective review level
Attends calls and e-mails from insurance companies, clients, and providers.
Makes suggestions to improve service.
Increase efficiency, minimize errors, and reduce administration time through AI-powered automation.

Key requirements/What you bring

Bachelor’s of Pharmacy / Dentistry / Medicine / Nursing / Physiotherapist / Paramedics
Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus) OR Entry Level
Physically fit to carry out duties.
Certified Medical Coder [Preferable]
Legally permitted to work in the country of operations.
Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
Certified Medical Coder is preferable, with familiarity in AI-driven coding tools being beneficial
Experience with AI tools and platforms relevant to claims processing and administration, enhancing operational efficiency and accuracy.

1 Job for Cost Containment Protocols in Egypt

Medical claims Officer - MCC