Claims Verification & Processing Officer

About the role

We are looking for a detail‑oriented Claims Verification & Processing Officer to join our team at Medscheme. You will play a key part in ensuring accurate and timely processing of outpatient claims across all schemes we administer.

Key responsibilities

• Verify claims for all Medscheme‑administered schemes.
• Ensure Service Level Agreements for outpatient claim refunds are met, provided all required information is complete.
• Maintain departmental quality standards with a minimum 95% accuracy rate for outpatient claims.
• Respond professionally to internal and external queries and requests.
• Follow up on emails and ensure responses within 48 hours.
• Capture outstanding claims as assigned by the Team Coordinator or Team Leader.
• Verify and process Payless claims when requested by management.
• Maintain accurate records and proper documentation of all claim processes.

Required profile

• HSC qualification.
• 2–5 years of experience in the insurance or medical field.
• Computer literate with good knowledge of standard office tools.
• Strong written and verbal communication skills.
• Proven data‑capturing abilities.
• Customer‑centric attitude.
• Good knowledge of health and medical processes and terminology.

Required skills

• Microsoft Office
• Data entry