Medical Claims Officer

Description:

The medical claims officer will provide quality service to clients, promptly and effectively assess and process OP claims according to operations set standards.

Key responsibilities / What you do:

• Manages routine daily claims administration work.
• Coordinates workflow and meets deadlines.
• Evaluates OP claims with regards to eligibility.
• Applies Nextcare cost containment protocols for OP claims at the retrospective review level.
• Attends calls and emails from insurance companies, clients, and providers.
• Makes suggestions to improve service.
• Increases efficiency, minimizes errors, and reduces administration time through AI-powered automation.
• 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.

Key requirements / What you bring:

• Bachelor’s degree in Pharmacy, Dentistry, Medicine, Nursing, Physiotherapy, or Paramedics.
• Medical practical experience (reputable insurance provider, broker, or a TPA experience is a plus) or entry level.
• Physically fit to carry out duties.
• Certified medical coder (preferable).
• Legally permitted to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
• Experience with AI tools and platforms relevant to claims processing and administration, enhancing operational efficiency and accuracy.

How we hire:

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:

Our employees play an integral part in our success as a business. We appreciate that each of our employees is unique and has unique needs and ambitions, and we enjoy being a part of their journey.

We are there to empower and encourage you with your personal and professional development, ensuring that you take control by offering a large variety of courses and targeted development programs. All that in a global environment where international mobility and career progression are encouraged.

Caring for your health and wellbeing is a key priority for us. This is why we build Work Well programs to provide you with peace of mind and give the flexibility in planning and arranging for a better work-life balance.

Our group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams, and challenges is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow, and to 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, and nurtures 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, sexual orientation, or any other characteristics protected under applicable local laws and regulations.

AI is revolutionizing customer service and claims management through innovative solutions. These AI-driven tools enhance productivity by streamlining complex claims processes, reducing administrative burdens, and accelerating resolution times. Our AI-powered technology has made claims processing faster, offering quicker resolutions, all while ensuring human oversight for claims to maintain service integrity.

By embracing AI and emerging technologies, we continue to lead the industry, meeting ever-changing customer needs with innovative solutions. Our commitment to ethical AI practices safeguards data integrity and trust, ensuring responsible deployment across all operations. This approach not only enhances customer experiences but also supports strategic initiatives like fraud detection and personalized product offerings, solidifying our position as a leader in the insurance sector.

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