Executive Panel

Key Responsibilities

• Review and process medical claims submitted through healthcare provider systems (approximately 80–100 claims per day)
• Validate claim details including diagnosis, treatment, cost breakdown, and supporting documents
• Ensure claims are processed in accordance with benefit policies, coverage limits, and exclusions
• Cross-check member eligibility, policy numbers, and treatment justifications
• Follow up with healthcare providers on missing or unclear documentation
• Liaise with panel providers, patients, insurers, and internal teams on claims-related matters
• Respond to claim enquiries and resolve issues in a timely manner
• Escalate complex or disputed cases to senior management or underwriting teams when required
• Maintain accurate records of claims, approvals, correspondence, and injection details
• Update claim status and generate reports via the TPA system
• Prepare claims re...