Claims Officer - Reimbursement

About the role

MedNet Egypt is seeking a diligent Reimbursement Claims Officer to manage and audit medical claims in line with coverage scopes, provider contracts, and payer SOPs. The role focuses on timely processing, fraud detection, and accurate reporting to support the organization’s managed‑care services.

Key responsibilities

• Process reimbursement claims within agreed turnaround times and target metrics.
• Evaluate claims against scope of cover, territorial limits, proof of payment, and detect potential fraud or unusually high billing.
• Adjudicate medical claims using system‑controlled exclusions and policy holder terms of business.
• Conduct medical audits, compare received claims with contracts, and ensure compliance before processing.
• Prepare daily, weekly, and monthly reports as required by supervisors.
• Print and manage bordereaux for processed claims, separate invoices by Primary Insurance Companies, and dispatch them as scheduled.
• Respond to email queries from insurance partners, clients, and internal teams.
• Monitor medical trends, flag suspicious cases, and inform team leaders to minimize insurance abuse.

Required profile

• Bachelor’s degree in Medicine, Pharmacy, or Dentistry.
• 0‑2 years of experience in a related field; insurance experience is a plus.
• Fluent English with strong verbal and written communication skills.
• Excellent time‑management, attention to detail, analytical thinking, and ability to meet tight deadlines.

Required skills

What we offer

• Opportunity to work within a leading managed‑care organization.
• Professional development in medical claims processing and audit.