Claims Service Officer

The Claims Service Officer plays a critical role in the assessment and processing of insurance claims for EFU Life Assurance Ltd. This position requires a proactive individual with strong customer service skills and a comprehensive understanding of insurance policies. The officer is responsible for visiting hospitals as per an assigned list to assess admissions, verify the identity of insured clients using their CNIC, and diligently address any challenges clients may encounter during their hospital stay. The ability to communicate effectively, coupled with a keen attention to detail and strong time management skills, is essential to ensure satisfactory claims processing.
Responsibilities

Conduct visits to various network hospitals and other designated facilities to oversee and facilitate the claims process effectively.
Assess patient admissions to verify insured individuals' identities through their CNIC and confirm compliance with insurance policies.
Document and report any customer difficulties encountered during hospitalization to the Head Office for prompt resolution and action.
Review patient files thoroughly to evaluate medical necessity for admissions, monitor treatment progression, and assess investigations performed.
Engage in discussions with supervisors regarding patient file assessments, ensuring comprehensive understanding and alignment with coverage limits.
Identify and report on unjustified or unnecessary patient admissions, helping to mitigate potential claims-related issues.
Monitor daily billing issues related to admissions and communicate necessary details of bill amounts to the supervisor in a timely manner.
Conduct verification of claims at non-network hospitals, extending services as required to nearby cities when applicable.
Partner with medical professionals and administrative staff to gather necessary documentation and facilitate efficient claims processing.
Maintain meticulous records of all claims processed, ensuring accuracy and compliance with regulatory standards.
Exhibit strong communication skills to interact effectively with clients, providing them with clear information and addressing any inquiries regarding their claims.