Officer - Claims

MedNet Jordan is one of the leading managed care service organizations that caters to healthcare needs. We are currently seeking to hire an Officer – Claims (on Hybrid working modules basis) with the following tasks and responsibilities:

Your Job

Medical Claims Processing

• Applying Claims Department Policy, Procedures and quality measures for processing claims.
• Processing Claims efficiently & accurately, according to FIFO (First In First Out) of providers network claims along with international claims through network providers.
• Process the EPD (Early Payment Discount) batches according to priorities as per assignment from Claims Team Leader.
• Entering data accurately in order to provide accurate records to the company and Participated Insurance Companies (PICs).
• Work in high speed and efficiency to achieve monthly targets.

Medical Claims Evaluation:

·       Authorization for in and out-hospital cases in respect of medical necessity and appropriateness.

·       Evaluation & approval of outpatient & Inpatient claims need authorization in respect to the medical necessity and appropriateness and check them in the system to ensure high quality and correct services.

·       Chronic soap evaluation, issue, checking, sign & stamp.

Quality & Audit of Claims Processed

• Conduct Medical Audit and review sample of Processed Claims – sample defined as per confidence level target set on a yearly basis - against scope of coverage and provider contracts as set in Claims Best Practice Manual.
• Checking batch list for printed out bordereau when required ahead of bordereau issuance.