Claims Registration & Processing

• Receive, review, and register medical claims in the claims management system within defined turnaround times.

• Verify completeness and accuracy of claim documentation prior to registration.

• Ensure correct member, provider, benefit, and policy details are captured.

• Maintain accurate digital and physical claims records.

• Flag incomplete or suspicious claims for further review.

Claims Reconciliation & Financial Accuracy

• Reconcile claims paid, claims processed, versus finance payment records.

• Reconcile provider statements against internal claims payment reports.

• Investigate and resolve reconciliation variances promptly.

• Work closely with Finance to ensure claims payment accuracy.

• Support month-end and year-end reconciliation processes.

Fraud Detection & Audit Support

• Identify unusual claim patterns or inconsistencies that may indicate fraud.

• Maintain audit-ready documentation for all reconciliations performed.

• Support internal and external audits by providing required data and explanations.

Corporate Governance & Compliance

• Ensure adherence to claims processing SOPs and internal control frameworks.

• Uphold strong data protection and confidentiality practices.

• Stay updated with regulatory requirements within the insurance industry.

Collaboration & Culture

• Participate in cross-functional projects to support innovation and accountability.

• Maintain strong teamwork, communication, and conflict resolution practices.

• Commit to ongoing skills development through training and professional growth plans.