Job Summary

Physician assistants (PAs) examine patients, prescribe medicine, and order diagnostic tests. In most cases, they work under the supervision of physicians or surgeons, but they can work more independently in some states, rural areas, and inner-city areas, consulting with physicians only when they need help with cases.

  • Minimum Qualification: Degree
  • Experience Level: Mid level
  • Experience Length: 1 year

Job Description/Requirements

Responsibilities:

  • Vetting of claims on structure OPD and Inpatient benefit filters
  • Ensure capturing of all incurred claims
  • Adjudicate claims administratively and medically
  • Reconciling claims reported with HSPs
  • Auditing claims with the priority of identifying fraud
  • Advice finance on processed claims for payment
  • Carry out quarterly clinical audits at the provider end
  • Keep an up to date record on all provider and member claims
  • Ensure proper conduct and high-performance level of claim officers
  • Coordinate activities of all claims officers to ensure effective and timely payment of claims
  • Produce monthly savings reports on rejections and cancelled fraudulent claims
  • Preparing weekly and monthly reports on all activities of the claims department.



Qualifications:

  • A Minimum of 1st degree is required
  • Minimum of 1 year of experience

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