Job Description

Job Responsibilities:

• Review health insurance policies to ensure they cover all agreed-upon items with the insured party.
• Analyze insurance benefits and compare them with approved contracts and contractual terms.
• Verify the accuracy of member (insured individuals) data and their corresponding coverages.
• Coordinate with insurance companies to clarify or amend any ambiguities or inconsistencies in documentation.
• Update policy details during renewals or amendments in coordination with the insured party.
• Document and monitor any exceptions or specific limits within each policy.
• Prepare reports outlining discrepancies or observations identified during the review process.
• Provide internal support to relevant departments (e.g., Finance or HR) regarding coverage and benefits.
• Contribute to enhancing internal policies related to insurance documentation management.

Qualifications

• Bachelor’s degree in Business Administration, Insurance, Healthcare Management, or a related field.
• Minimum of 2–3 years reviewing health insurance documents.
• Strong understanding of insurance coverage types and policy terms.
• Proficiency in MS Office (especially Excel) and insurance management systems.
• Ability to analyze legal or semi-legal documents.

Required Skills

• Accuracy and attention to detail
• Strong analytical and organizational skills
• Excellent verbal and written communication skills
• Ability to understand insurance and medical terminology
• Problem-solving skills