Senior Medical Claims Officer

About the role

The Senior Medical Claims Officer leads the claims team for the Operation & Health programme in Cairo, controlling and monitoring project total medical expenditure. The role verifies and checks invoices and claims from providers, suppliers, vendors and subcontractors so that all project expenditures are captured and properly recorded. It reports to the Senior Program Manager and supervises three Medical Claims Coordinators and one admin staff member.

Key responsibilities

• Lead the medical claims structure, which is autonomous from the medical team responsible for service delivery and case management.
• Manage the medical claims review process, approve reports and documents from health providers, and sign off final claims reports with comments and deductions.
• Supervise the medical claims coordinators who review claims submitted by hospitals.
• Review price lists and compare providers during the contracting phase, and lead corrective actions on medical documentation required for claims settlement.
• Coordinate with the finance team on claims review, deductions communicated to hospitals, payment approval and payment processing.
• Monitor the status of referrals, commitments and claims until project closure, and prepare monthly spending and forecasted reports with the health program manager.
• Ensure claims comply with Egyptian law, SCI policies and donor requirements, and support cost control through forecasting and variation reporting.
• Review and sign off medical cash payments for beneficiaries, and guide health service providers to improve the accuracy of their reports.
• Take part in medical audits and ensure timely and complete claims reporting.

Required profile

• Bachelor of Medicine (BSc in medicine and surgery) is mandatory.
• 5-7 years of experience in medical claims auditing, project cost planning and reporting.
• Experience in a healthcare setting is highly desirable.
• Good command of English, spoken and written.

Required skills

• A certificate in auditing and cost control is highly desirable.
• Strong computer skills in MS Office, especially MS Excel.
• Analytical, problem-solving and project management skills, with technical writing ability.