 Review and process medical claims submitted by members or healthcare providers.

 Check documents for completeness, including medical abstracts, itemized statements, and official receipts.

 Verify member eligibility, benefits coverage, and policy limits.

 Apply appropriate coding and benefits computation based on the member’s plan and HMO rules.

 Bachelor’s degree in Business administration, Healthcare Management, Nursing, or a related field is preferred.

 A diploma in medical, healthcare, or business-related field may be considered.

 1-2 years of relevant experience in medical claims processing or administrative support in healthcare, hospitals, clinics, or insurance/HMO industries.

 Familiarity with medical billing and reimbursement processes.

 Experience working with HMO procedures and healthcare provider networks is a plus.