We are looking for a Senior Claim Specialist to manage insurance claims processing, rejection analysis, and claims reconciliation across pharmacy operations. The role will work closely with pharmacists, TPAs, and insurance providers to ensure accurate claim submissions, compliance with Nphies and CCHI regulations, and timely financial recovery.
Key Responsibilities
- Review and process insurance claims and e-claims submissions.
- Analyze claim rejections and coordinate resubmissions with supporting documentation.
- Ensure compliance with Nphies standards and CCHI regulations.
- Monitor claim payments, reconciliations, and collection reports.
- Prepare periodic reports on submissions, rejection trends, and recovery rates.
- Coordinate with internal teams and insurance stakeholders to resolve claim issues.
Requirements
Requirements
- Bachelor’s degree in Insurance or related field.
- Minimum 2 years of experience in insurance claims processing.
- Previous experience in a pharmacy chain is required.
- Knowledge of Nphies platform, ICD-10 AM coding, and insurance regulations.
- Strong analytical and communication skills.
