Claims Processor (Non-Medical)

Your tasks

• Receive, review and validate the submitted hardcopy claims from providers.
• Assure the completeness of needed documents in compliance with GM Egypt procedures.
• Compare and validate the NP (Network provider) code stated on the print out bordereaux vs. the provider’s name mentioned on the submitted statement.
• Adjust the online transactions vs. the hardcopy claims and perform the required adjustments.
• Add any additional claims adjustments if needed on I*Geme.
• Report the adjustment reasons on the statements and claims delivery reports.
• Perform data entry process of claims submitted by the off-line providers.
• Assure the proper application of I*Care by the providers.
• Report missing services or items per provider and any tariff mismatching items regularly.
• Handle the filing and sorting of deductions softcopy for all the healthcare service providers according to their categories.
• Follow-up on claims reception according to pre-set schedule.
• Send the adjusted claims to the specified shared folder.

Implement proper sorting and filing of claims.

Requirements

• BS degree in information systems, business administration or any related field.
• Previous experience in data entry or claims processing.
• Ability to deal with MS Office applications and computer literate.
• Good command of English language.
• Target-oriented, hard-working and ability to stick to tight deadlines.
• Strong Analytical skills, organizational skills with the ability to handle multiple assignments.