Manager - Medical Claim Operations

5 days ago

Wah Cantonment Punjab, Pakistan LINRCO Pakistan Full time 900,000 - 1,200,000 per year

Job Description

To ensure that assigned provider's Inpatient and Outpatient claims are medically & commercially

adjudicated within the specified timeframe and within the targeted quality to achieve the business

objective of ensuring that BUPA delivers high quality claim statements.

Adjudication


• Process all the daily batches of claims assigned in line with medical policy and Inpatient / Outpatient adjudication guidelines while using his/her medical background in conjunction with the

instructed guidelines, day-in-day-out for smooth operation of business activity


• Assures that each claim has been processed as per the checklist of steps involving checking of

physical claim (or scanned image on the document management system), and cross checking with

the electronic claims data on Edge, and reflecting the right decision for every claim on the

operations system


• Achieve daily target in terms number of claims processed


• Discusses all high profile/high value claims with the claims medical manager where the decision

is difficult & well thought

Quality


• To achieve required quality through achieving at least 95% accuracy level on monthly quality

audits, in order to maintain the quality standard set for the job


• Makes sound medical decisions that minimize the opportunity to be challenged by providers, and

consults with the medical manager where in doubt

Fraud and abuse identification


• Reports abnormal trends of provider practice for adjudicated claims where needed.


• Detects and escalates FWA cases to the concerned teams in line with Claims handling guidelines

Skills


• Good English Skills


• Good Communication Skills


• Clinical Experience


• Medical Insurance Experience Preferable

Education

MBBS (Bachelor of Medicine & Surgery)

  • Medical Billing Team Lead

    2 weeks ago

    Johar Town, Punjab, Pakistan OctaMD Full time 900,000 - 1,200,000 per year

    Company DescriptionOctaMD is dedicated to revolutionizing the medical billing industry with a comprehensive range of services aimed at streamlining processes, enhancing revenue, and enabling healthcare providers to focus on exceptional patient care. Our blend of advanced technology and industry expertise delivers solutions designed to enhance operational...

  • AR Executive-Medical billing

    3 days ago

    Johar Town, Punjab, Pakistan OctaMD Full time 500,000 - 1,500,000 per year

    Job Title: AR Specialist – Medical Billing ( onsite)Job Description:We are seeking a detail-oriented and proactive Accounts Receivable (AR) Specialist to join our medical billing team. The ideal candidate should have strong experience in insurance and patient AR follow-up, a good understanding of claim submission protocols, and excellent communication...

  • Operations Manager

    22 hours ago

    Wah Cantonment, Punjab, Pakistan Fame Technologies Full time 900,000 - 1,200,000 per year

    Company DescriptionFame Technologies delivers advanced industrial automation and engineering solutions, specializing in CNC retrofitting, custom machine design, and smart manufacturing systems. Integrating mechanical, electrical, and electronic expertise, Fame Technologies helps businesses transition into the Industry 4.0 era. We enhance efficiency, safety,...

  • Medical Officer

    2 weeks ago

    Islamabad, Punjab, Pakistan Medical Billing Diploma Program - Riphah International University Full time

    Job Description (total positions: 1, posted on: Oct 22, 2025)In this role, theMedical Officer will be responsible for theclinical management and continuous monitoring of patients admitted to the ICU. The incumbent will perform essentialinvasive and non-invasive procedures, includingendotracheal intubation andventilator support management.**The Medical...

  • Associate Operations Coordinator

    2 weeks ago

    Wah Cantonment, Punjab, Pakistan LINRCO Pakistan Full time $104,000 - $130,878 per year

    Job Description:Responsible for the end-to-end Operations Process of all Industrial (Oil & Gas) and Engineering, and other Clients' business sector.Review, manage and timely process of all requests in a highly professional way fulfilling Clients and employees' expectations.Scheduling meeting with new Clients to set a standard for smooth flow of every process...

  • Ass. Operations Coordinator

    1 week ago

    Wah Cantonment, Punjab, Pakistan LINRCO Pakistan Full time

    Job location: Wah Cantt( Candidate from Wah Cantt are preferred)Job Description:Responsible for the end-to-end Operations Process of all Industrial (Oil & Gas) and Engineering, and other Clients' business sector.Review, manage and timely process of all requests in a highly professional way fulfilling Clients and employees' expectations.Scheduling meeting...

  • Associate Human Resources Operations Coordinator

    3 days ago

    Wah Cantonment, Punjab, Pakistan LINRCO Pakistan Full time 80,000 - 120,000 per year

    Job location: Wah Cantt(Candidate from Wah Cantt will be considered )Job Description:Responsible for the end-to-end Operations Process of all Industrial (Oil & Gas) and Engineering, and other Clients' business sector.Review, manage and timely process of all requests in a highly professional way fulfilling Clients and employees' expectations.Scheduling...

  • Sales Representative

    1 week ago

    Johar Town, Punjab, Pakistan OctaMD Full time 400,000 - 600,000 per year

    About us:OctaMD is dedicated to transforming the medical billing industry with a comprehensive suite of services designed to streamline processes, enhance revenue, and empower healthcare providers. Our services, including medical coding, claim submission, denial management, and patient scheduling, aim to improve operational efficiency and financial...

  • Accountant ERP

    1 week ago

    Wah Cantonment, Punjab, Pakistan BTB Consulting- Private Limited Full time 400,000 - 1,200,000 per year

    Note: Applications are only open to people living in or near Wah Cantt.Company DescriptionBTB Consulting- Private Limited specializes in Chartered Management Accountancy and provides high-quality consulting services for Microsoft Dynamics 365 Finance and Operation, Microsoft Dynamics 365 Business Central, and Microsoft Dynamics 365 CRM. We are committed to...

  • Operations Manager

    5 days ago

    Ali Pur Chatta, Punjab, Pakistan NRSP Microfinance Bank Full time 600,000 - 800,000 per year

    Company DescriptionNRSP Microfinance Bank is the result of the National Rural Support Programme's 18 years of experience in harnessing people's potential through social mobilization. It aims to bring economic and social change by providing a variety of financial services. The bank emerged from NRSP's microcredit operations, which began in 1993. The NRSP...