Specialist, Claims

Role Overview

This position focuses on supporting the end-to-end handling of inpatient claims, with an emphasis on precise evaluation, verification, and payment processing in line with company guidelines and applicable industry requirements. The role helps maintain the speed, accuracy, and reliability of the claims function while working closely with both internal teams and outside partners.

Core Accountabilities

• Manage inpatient claims activities from review through completion.
• Check claim details carefully to confirm accuracy and policy compliance.
• Validate submissions against internal rules, procedures, and sector standards.
• Work with internal departments and external stakeholders to resolve claim-related matters.
• Review claims data to support informed processing and decision-making.
• Apply quality control steps that strengthen the consistency and integrity of the claims workflow.

Additional Information

The role contributes to an efficient claims management process by combining analytical review, stakeholder coordination, and quality assurance practices.