Claims Vetting Officer

Role Description

This is a full-time on-site position for a Claims Vetting Officer, based in Accra. The Claims Vetting Officer will be responsible for reviewing, validating, and analyzing insurance claims, ensuring compliance with company policies and industry regulations. Day-to-day tasks include evaluating submitted claims, verifying their accuracy and eligibility for approval, and ensuring timely processing. The officer will also liaise with clients and healthcare providers, resolve claims-related inquiries, and contribute to improving claims management processes.

Key Responsibilities

• Review and vet medical claims submitted by accredited providers for completeness, accuracy, and policy compliance
• Verify eligibility, benefit limits, tariffs, and treatment appropriateness before approval
• Detect irregularities, overbilling, duplicate claims, and potential fraud indicators
• Liaise with healthcare providers and internal teams to resolve claim discrepancies
• Ensure claims are processed within defined turnaround times and service standards
• Maintain accurate records and documentation for audit and compliance purposes
• Support provider education on claims submission standards and documentation requirements
• Generate periodic reports on claims trends, variances, and exceptions
• Uphold confidentiality and data protection standards in handling member information

Qualifications & Requirements

• Bachelor’s degree in Health Information Management, Nursing, Pharmacy, Medicine, Insurance, or a related field
• Licensed medical professionals are encouraged to apply
• Minimum 2–4 years’ experience in claims vetting, medical auditing, or health insurance operations
• Excellent Analytical Skills for evaluating and verifying claims
• Exceptional Communication skills, both written and verbal, to liaise with stakeholders effectively
• Proficiency in Microsoft Office Suite and claims management software is an advantage
• Strong understanding of Ghana’s health insurance framework and NHIA requirements
• Sound knowledge of medical terminology, treatment protocols, and billing practices
• Highly attentive to detail with strong analytical and investigative abilities.
• Proficiency in Microsoft Office and claims management systems
• Excellent communication and stakeholder management skills
• Integrity, discretion, and sound judgment

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