Claims Submission and Data Reporting Officer

Review prepare and submit insurance or healthcare claims to various providers and organizations Ensure claims are submitted accurately and within designated timelines Identify and resolve any discrepancies or errors in submitted claims Work closely with internal teams e g billing customer service to obtain any missing information and ensure claim accuracy Maintain a tracking system to monitor the status of submitted claims and follow up as necessary

Compile analyze and generate regular reports on claims data including submission statuses payment details denials and adjustments Prepare monthly quarterly and annual reports for internal stakeholders or external regulatory bodies Ensure reports meet the required standards for accuracy compliance and timeliness Conduct trend analysis to identify opportunities for process improvements and cost savings

Stay updated on relevant regulations industry standards and best practices related to claims submission and reporting Ensure all claims and data reporting activities comply with company policies and regulatory requirements Maintain thorough documentation of claims processes outcomes and communications for audit purposes

Communicate effectively with clients insurance providers or other third-party organizations to resolve issues related to claims submissions and payments Coordinate with internal teams including finance customer service and operations to streamline claims processes Provide insights to management and other stakeholders regarding claims trends potential issues and recommended solutions

Identify inefficiencies or challenges in the claims submission and reporting process Work with the team to develop and implement solutions to improve accuracy speed and efficiency Recommend updates to systems or software to streamline data collection claims tracking and reporting

Experience with healthcare reporting and data validation. Proficiency in Microsoft Excel, including the ability to create and manage spreadsheets, use formulas, pivot tables, and generate reports. Familiarity with medical coding (ICD & CPT), claim submission processes, and healthcare insurance regulations (HAAD/DOH). Strong attention to detail, analytical skills, and ability to work collaboratively with cross-functional teams. Strong proficiency in Microsoft Excel, including advanced functions such as VLOOKUP, pivot tables, and data analysis tools.

Strong organizational and time management skills.