We are looking for a Senior Medical Claims Officer that will be responsible for providing quality medical care and handle all medical issues in order to ensure excellent service for the insured.

Key Responsibilities:
Claims Processing:
- Handle direct requests and claims by applying underwriting guidelines and policy conditions, and coordinating between the underwriting department and Third Party Administrator.
- Process urgent requests and prior approval cases, while coordinating with the Third Party Administrator.
- Finalize and follow up on reimbursement of claims with the Third Party Administrator.
- Record details of inquiries, comments, complaints and action taken accordingly.
- Process orders and requests with the Management for exceptional or ex-gratia coverage as per predefined procedure.
- Register ex-gratia cases in order to have an estimation at the end of the quarter/year.
- Process coverage request from broker fund or account when applicable.
- Manage broker claims payments and fund balance when applicable.

Customer service:
- Constantly handle, coordinate and deal with brokers/Clients requests reported directly or through Business Units to provide quality customer service.
- Communicate and coordinate with internal departments, in order to ensure
customer satisfaction.
- Advise broker or branches on appropriate action when needed, and follow up to ensure efficient problem resolution.

Education, Experience and Qualifications:
- Bachelor degree in nursing or any related medical field
- Minimum 7 years of relevant experience.
- Communicate clearly and concisely with internal and external stakeholders and demonstrate strong problem-solving skills to efficiently resolve complex claims issues.
- Possess a keen eye for detail to accurately review and process claims, ensuring all information is correct and complete.
- Effectively manage a high volume of claims, prioritize tasks, and consistently meet deadlines.
- Demonstrate empathy and compassion to understand and respond to the needs of customers, particularly during challenging times.