Health Insurance Denial & Claims Specialists

Company Description

Quantum Edge Technologies PLC is a leading IT solutions provider dedicated to transforming businesses through innovative technology. Our team offers cutting-edge services tailored to meet the specific needs of each client, enhancing operational efficiency and competitive advantage. Located in Addis Ababa, Ethiopia, we focus on empowering businesses with advanced IT infrastructure and support. We are committed to delivering excellence and fostering growth in every project we undertake.

Role Description

We are seeking skilled and dedicated Health Insurance Denial & Claims Specialists (BPO Setting) to support patients, clinics, and hospitals in managing their health insurance claims. You will be responsible for:

• Reviewing denied claims
• Correcting errors
• Filing appeals to obtain coverage and payments

Key Responsibilities

• Process and submit health insurance claims on behalf of patients, clinics, or hospitals.
• Follow up with insurance companies via phone, email, and portal to ensure timely resolution.
• Correct errors in denied claims and resubmit them to payers for reconsideration.
• Obtain insurance coverage for costs accrued by patients, ensuring they receive the benefits entitled under their plan.

Qualifications

• Strong Communication and Customer Service skills
• Familiarity with claim submission platforms
• Proficiency in Health Insurance and general insurance policies and procedures
• Knowledge of ICD-10 medical coding
• Excellent problem-solving and analytical skills
• Excellent attention to detail, documentation, and follow-up skills
• Experience within the healthcare or insurance industry is a plus
• Bachelor’s degree in Business, Healthcare Administration, or related field is preferred

Skills Required:

• Health / Medical
• Sales / Marketing / Business / Management