Qualifications & Requirements
Applicants must meet the following requirements:
Diploma or Degree in Clinical Medicine, Business Administration, Health Records, Finance, or any other relevant business/health-related field
Minimum of three (3) years' relevant experience in a busy private hospital setting
Strong and proven knowledge of SHA (Social Health Authority) claims processes and other private insurance schemes
Good understanding of hospital billing, pre-authorizations, claim submissions, and reconciliation processes
Experience in handling claim rejections, resubmissions, and follow-ups with insurers
Familiarity with hospital management systems and electronic claims processing will be an added advantage
Strong analytical, numerical, and documentation skills
High level of accuracy, integrity, and attention to detail
Excellent communication and follow-up skills with insurers and internal hospital departments
Ability to work effectively under pressure in a fast-paced environment with strict deadlines
Key Responsibilities
The successful candidates will be expected to:
Process and submit insurance claims accurately and in a timely manner in line with SHA and private insurer requirements
Review patient documentation to ensure completeness and compliance before claim submission
Follow up on pending, rejected, or queried claims with insurance providers
Conduct claim reconciliation and assist in resolving variances between billed and paid amounts
Ensure proper coding and documentation support for all submitted claims
Collaborate closely with clinicians, billing, and finance teams to ensure accurate claim preparation
Maintain organized records of all claims submitted, paid, pending, or rejected
Support pre-authorization processes and verification of patient eligibility where required
Monitor claim performance and provide regular reports on claim status and trends
Ensure compliance with insurance policies, hospital procedures, and regulatory requirements