JOB DETAILS:
Job Description
The Medical Claims Analyst - Vetter plays a crucial role in ensuring that medical insurance claims are processed accurately and efficiently. This position involves reviewing claims for completeness, verifying the authenticity and accuracy of medical services provided, and ensuring compliance with company policies and regulations. The Medical Claims Analyst - Vetter works closely with healthcare providers, medical professionals, and the Old Mutual’s claims team to resolve discrepancies and approve claims for payment.
• Claims Review & Verification:
Review and vet incoming medical claims for completeness, accuracy, and adherence to insurance policies and procedures.
• Compliance & Regulatory Standards:
Ensure that claims meet industry regulations, billing guidelines, and company policies before processing.
• Documentation Review:
Evaluate supporting documentation (such as medical records, treatment plans, and itemized bills) to validate claims.
• Error Identification & Resolution:
Identify errors or discrepancies in claims, including coding mistakes, incorrect billing, or incomplete information, and work with the appropriate parties to resolve issues.

• Communication with Healthcare Service Providers & Internal Teams:

Communicate with healthcare providers, medical professionals, and internal teams to clarify or request additional information needed to process claims.
• Claims Reconciliations:
Assist with reconciling medical claims disputes, providing clear reasoning for rejection and helping resolve issues through the appeals process.
• System Data Entry:
Accurately enter claims data into claims management systems and ensure the information is up to date.
• Continuous Improvement:
Recommend improvements to claims processes, policies, and training materials to enhance efficiency and accuracy.

Qualifications:
• Education:
High school diploma or bachelor’s degree in healthcare course such as Medicine, Nursing, Clinical Medicine, or any other healthcare related discipline.
• Experience:
experience in medical claims processing, insurance, or healthcare industry is preferred.

Skills & Abilities:
o Strong attention to detail and analytical skills
o Excellent organizational and time management skills
o Strong verbal and written communication skills
o Knowledge of medical systems is preferred
o Proficiency in computer skills & Microsoft Office Apps
o Ability to work independently and as part of a team

o Ability to handle confidential information with discretion

Education
• Bachelor of Health Studies (BHS): Nursing (Required), Diploma (Dip): Nursing (Required)