Claim Analyst Reimbursement Senior

Job Description :

Analyze and process health insurance reimbursement claims, primarily inpatient claims.

Review medical documents, diagnosis, treatment, and claim documents to assess eligibility and accuracy.

Validate claims against policy benefits, coverage, exclusions, and applicable terms & conditions.

Handle reimbursement claims for both corporate and individual members .

Manage and resolve complex claim cases , including discrepancies and potential irregularities.

Coordinate with members, corporate PICs, healthcare providers, agents, and internal teams when required.

Ensure accurate and timely claim processing in accordance with SLA/TAT and company procedures.

Support claim billing, reporting, and documentation processes.

Identify opportunities for claim process improvement and provide recommendations.

Requirements :

Minimum Bachelor's degree in Nursing .

Minimum 3 years of experience in Health/Reimbursement Claims, preferably with inpatient reimbursement experience .

Strong understanding of medical documents, claim analysis, and policy benefits.

Strong analytical, problem-solving, communication, and attention-to-detail skills.

Able to work independently and collaborate effectively with multiple stakeholders.