Health Claims Officer

We are seeking to recruit an Operations Officer within the Bupa Malta claims team. We need you to be a positive person, who thrives in working within a team and have an eye for detail. We take pride in giving our clients outstanding customer service, so you would need to have excellent communication skills. Experience or relevant qualifications will be an asset, however we do provide on the job training.

Main Responsibilities:

  • Examine claims records and forms to determine whether the patient has medical insurance.
  • Review provisions of certificate or policy to determine the patient’s included medical coverage losses
  • Properly document medical claims; update and maintain databases
  • Reject or accept documentation, determine benefit due, and start the payment or denial process to resolve medical claims
  • Examine medical treatment records, police reports, physical property damage and medical bills to gauge overall extent of liability
  • Communicate claim decisions to the insured
  • Preparing ad-hoc statements
  • Adhere to all company policies, procedures and guidelines in addition to local insurance regulations
  • Maintain excellent customer care services with all clients
  • Ensure all claims information remains confidential
  • Other reasonable duties and responsibilities within the overall function, which may be assigned from time to time.

 

Other Responsibilities (Risk Related):

  • Maintain a comprehensive overview of the processes within your section and report any key business risks across all levels to the Branch Manager promptly
  • Assist your superior or senior management to develop, communicate and instill a risk management culture
  • Encourage / motivate your colleagues in risk management principles and practices

 

Knowledge / Skills / Qualifications:

  • Experience in Health Insurance Claim settlement or a similar role
  • Organised and IT Proficient
  • Fluency in written and spoken Maltese & English
  • CII certification would be considered an asset

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