Job Description

2.1 Resubmission Officer will be responsible for filing and tracking insurance claims and informing patients of their claims status. Process

• Review and audit medical claims to ensure accuracy and completeness.
• Handle the resubmission of rejected claims.
• Ensure agreed price lists and insurance provider manuals are followed when billing services to respective payers.
• Ensure Billing Officers are promptly informed of claim rejections and corrective actions are implemented to prevent recurrence.
• Coordinate with respective doctors to obtain necessary justifications for rejected claims and prepare them for resubmission.
• Submit claims with accurate codes and required formats to insurance companies within stipulated timelines.
• Perform any other duties assigned by the HOD within the scope of the job role.
• Comply with all OSH and infection control policies, standards, and procedures.
• Follow documented OSH procedures, instructions, and assigned responsibilities.
• Maintain awareness of emergency and evacuation procedures.
• Report OSH hazards, incidents, near misses, and other safety-related issues promptly.
• Assist in the preparation of risk assessments and incident reports.
• Comply with waste management policies and procedures.
• Attend applicable OSH and infection control training programs, mock drills, and awareness programs.
• Ensure the appropriate use of personal protective equipment (PPE) and safety systems.
• Ensure employees comply with applicable OSH and infection control policies, procedures, and standards.
• Provide OSH-related information, training, and supervision to staff.
• Report departmental OSH-related incidents, near misses, and hazards in a timely manner.
• Ensure corrective actions arising from incidents are properly implemented.
• Assist with the preparation of risk assessments and monitor the effectiveness of control measures.
• Ensure required training programs are conducted, including general, departmental, FMS, and OSH orientation for new and transferred employees, as well as refresher training for departmental staff.

• Bachelor’s degree or equivalent qualification in a Medical/Paramedical field, such as Nursing, Pharmacy, or related disciplines, from a recognized university.
• Minimum 2 years of experience in Insurance Claims Management/Adjudication.
• Experience in Medical Coding is preferred.
• Excellent command of spoken and written English