Overview
The Medical Claims Coordinator is responsible for auditing and verifying all medical records and financial claims received from healthcare service providers, ensuring accuracy and compliance with guidelines.
Tasks Summary
- Validate medical information and claims received from healthcare service providers.
- Proofread and verify data for completeness and accuracy, identifying and correcting errors or omissions.
- Communicate with healthcare providers and SCI Medical Coordinators to verify and clarify information and documentation.
- Review medical records, patient histories, billing documents, and related files to determine coverage, payment amounts or overpayments, and patient conditions.
- Ensure medical bills comply with agreed contract price lists.
- Maintain effective professional communication with all healthcare providers and suppliers.
- Ensure full compliance with SCI finance and procurement policies, procedures, and guidelines.
- Accurately enter and manage data related to medical bills and claims.
- Prepare regular reports by collecting, analysing, and summarizing relevant information.
- Draft necessary correspondence, forms, invoices, and other required documents.
- Perform other related tasks as assigned by the line manager.
- Ensure the mainstreaming of SCI’s Child Safeguarding Policy in all program activities.
- Provide technical support or training to field teams on proper documentation and claim submission procedures
- Participate in internal or external meetings related to health service provision, vendor management, or case review.
- Uphold and ensure adherence to SCI policies and procedures to maintain operational efficiency.
- Review and follow up on medical-related cases received from the Accountability/Aswan MEAl team, ensuring accurate verification, proper documentation, timely resolution, and feedback provision in line with SCI procedures.
Experience Requirements
- Proven experience in reviewing and auditing medical claims is essential.
- 1–3 years of successful experience in projects with a reputable humanitarian NGO in Egypt, preferably in the health sector.
Qualification Requirements
• Bachelor’s degree in medicine.
