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We are hiring “Medical Claim Officer” at Systems Limited (Lahore).

Requirements:

Education: A-Pharmacy, B-Pharmacy, Dispensary Clinical Assistant degree from a recognized university.

Experience: Minimum 3–4 years of relevant experience in medical field claim verification, hospital administration, or insurance medical review.

Familiarity with corporate health insurance policies and medical claim processes.

Strong understanding of OPD procedures, medications, and diagnostics.

Key Responsibilities:

Review and verify all OPD medical claims submitted by employees.

Assess the medical necessity and validity of treatments, prescriptions, and investigations.

Cross-check the submitted bills, consultation slips, and reports against the prescribed treatment.

Approval of verify claims on SAP.

Ensure all claims are in line with company medical policy and insurance terms.

Identify and highlight any discrepancies, ineligible expenses, or fraudulent claims.

Coordinate with the insurance provider (IGI) for clarification or additional verification when required.

Provide proper information to employees regarding claim approvals, rejections & deductions.

Manage queries of employees via MS. Teams & Emails.

Maintain accurate records and ensure timely processing of verified claims.

Interested candidates can share their resumes at talent@systemsltd.com and mention the job title in the subject line.