Benefits & Claims Coordinator

Responsibilities

• Manage the complete lifecycle of OPD claim processing from submission to reimbursement
• Review medical bills, prescriptions, and receipts to ensure compliance with company policies
• Verify claim eligibility, documentation accuracy, and reimbursement limits
• Coordinate with employees regarding claim submissions and status updates
• Liaise with insurance providers and third-party administrators (TPAs) to facilitate smooth processing
• Maintain accurate employee medical records, OPD utilization reports, and reimbursement trackers
• Prepare monthly and quarterly reports on claims utilization and reimbursement trends
• Identify discrepancies, duplicate submissions, or potentially fraudulent claims
• Maintain strict confidentiality while handling employee medical and personal information

Requirements

• Bachelor's degree in Business Administration, Human Resources, Healthcare Management, or a related field
• 1–3 years of experience in medical billing, OPD claims administration, or employee benefits
• Strong understanding of health insurance and OPD reimbursement policies
• Proficiency in Microsoft Excel and experience using HRIS or claims management systems
• Excellent attention to detail and documentation skills
• Strong analytical, organizational, and problem-solving abilities

Preferred Qualifications

• Experience working with corporate health insurance providers or TPAs
• Familiarity with healthcare compliance practices
• Knowledge of medical billing terminology
• Experience preparing claims reports and utilization analytics