Claim Analyst

Responsibilities:

• Supervise and provide daily operational support to Claim Analysts Head to ensure efficient workflow and service delivery.
• Review, evaluate, and approve complex or high-value claims in accordance with policy and medical guidelines.
• Monitor team performance against SLA, accuracy, and productivity.
• Handle escalated cases, disputes, and critical claims with strong judgment and stakeholder coordination.
• Conduct quality control reviews and continuously improve claim processes.
• Actively participate in claim system development and enhancement initiatives, ensuring alignment with business needs.
• Provide business and medical insights to strengthen claim rules, fraud detection, and automation processes.

Requirements:

• Bachelor's Degree in Medicine.
• Min. 5-6 years of experience as claim analyst in the insurance industry.
• Proven experience in handling medical claims, including complex and high-value cases.
• Exposure to healthcare providers, hospital billing, or utilization review is an advantage.
• Required Skill(s): Strong knowledge of Medical claims assessment, Data analysis and reporting, Process improvement, Strong analytical and problem-solving abilities, Effective communication, Attention to detail and high level of accuracy and Ability to work under pressure and manage multiple priorities.