Claims Representative

**JOB PURPOSE**



**The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per terms of benefits. He/She should provide accurate and relevant medical coverage details and maintain pre-approvals and claims processing as per the defined terms and policies of the organization.**



**RESPONSIBILITIES AND DUTIES**



+ Processes claims from providers.

+ Assesses and processes claims in line with the policy coverage and medical necessity.

+ Be fully versed with medical insurance policies for various groups / beneficiaries.

+ May assist in training colleagues and asked to share knowledge.

+ Accurately assesses eligibility within the policy boundaries.

+ Monitors and maintains the claims processing as per the defined terms and ...