Claims Officer

Job overview

The role of claims officer involves processing medical claims for clients worldwide. We ensure a high level of client service while processing claims within an industry-leading 48 hours.

The claims officer adjudicates medical providers’ claims, making sure that services are eligible as per policy terms and conditions, are in correlation with the authorized guarantee of payment given, and are paid as per the agreed tariffs with providers.

The claims department is a very fast-paced and challenging environment, with many different languages used and a mixture of cultures.

What you do

Key responsibilities

• Adjudicate and process claims within the agreed company SLA - clear to zero, in accordance with policy benefits to facilitate the company achieving its loss ratio target
• Use client database accurately and effectively to ensure reports generated give a true reflection of the department’s workload, which consequently facilitates effective target planning
• Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention
• Contribute to the team and departmental productivity targets so that the agreed SLA is achieved and a high level of customer service is provided
• In line with the company’s policy on cost containment identify duplicate payments, overbilling, up coding, possible non-disclosure and fraudulent claims
• Respond to customer enquiries accurately and professionally and if necessary, liaise with other departments for support to ensure an efficient and professional response is given thereby achieving customer satisfaction
• Participate in departmental medical training to expand knowledge of medical terminology and procedures and to develop comprehensive claims processing skills
• Assume additional tasks to effectively support the team leader to deliver on team KPIs and deputise for team leader, as needed
• Give support and guidance on escalated issues, complaints and challenging claims and lead by example
• Ensure adaptability in various claims handling work-related tasks to be able to facilitate a multi-tasking role
• Ensure that high quality targets (standard of work performance) are achieved at all times
• Support your team leader to drive engagement within the team
• Assist the in-house medical team by using AI models to streamline client hospital admissions, evacuations, repatriations, and other cases, ensuring efficient and effective service
• Use AI to automate routine tasks, speeding up the adjudication process and ensuring claims are processed efficiently, thus helping achieve the loss ratio target
• Enhance the use of the client database by AI analytics, providing deeper insights and generating more accurate reports, facilitating better target planning
• AI readiness: Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use

What you bring

Key requirements:

• 1-2 years’ experience in a customer-focused environment, ideally in clinical, paramedical roles or TPA or insurance roles
• Proficiency in MS Office
• Completion or progression towards the Diploma in Private Medical Insurance
• A highly customer-focused individual with strong interpersonal, communicative and accuracy skills
• Team player
• Physically fit to carry out duties
• Ability to demonstrate sound work ethics
• Ability to work under pressure and to meet tight deadlines and service standards

How we hire

Agency statement: We do not accept unsolicited CVs or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.

Key benefits / What we offer

We are a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech high-touch products and solutions that go beyond traditional insurance. Our products are embedded seamlessly into our partners’ businesses or sold directly to customers, and are available through four commercial brands.

Artificial intelligence (AI) is transforming service delivery and innovation. By leveraging business intelligence and data analytics, we enhance strategic decision-making and customer experiences. Our commitment to ethical AI ensures responsible deployment, maintaining data integrity and trust. Conversational AI improves communication, while emerging technologies and generative AI drive industry leadership and new opportunities. With robust information security management, we protect sensitive information, ensuring compliance and security. Embrace the future of AI with us, where possibilities become realities.

We are part of a trusted global group known for caring for our employees, their ambitions, dreams and challenges. Together we build an environment where everyone feels empowered and has the confidence to explore, grow and shape a better future for our customers and the world around us.

We stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. The foundation for this is our inclusive workplace, where people and performance both matter, nurturing a culture grounded in integrity, fairness, inclusion and trust.

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

Great to have you on board. Let's care for tomorrow.

Note: Having different strengths, experiences, perspectives and approaches is an integral part of our company culture. One means to achieve this is a regular rotation of executive employees across functions, entities and geographies. Therefore, the company expects from its employees a general openness and a high motivation to regularly change positions and collect experiences across the group.