Submission & Resubmission Officer – Healthcare Claims

About the role

The Submission & Resubmission Officer ensures that medical claims are submitted accurately and on time, while handling any denied or rejected claims to achieve optimal reimbursement for the hospital. This role works closely with internal departments and external payers to maintain smooth revenue cycle operations.

Key responsibilities

• Submit claims and required documentation within established timelines.
• Review rejected or denied claims, correct issues, and prepare resubmissions.
• Verify claim completeness, coding accuracy, and supporting documentation before submission.
• Monitor claim status, follow up on pending, rejected, or returned claims.
• Investigate reasons for rejections and coordinate with relevant departments to resolve them.
• Maintain accurate records of submissions, resubmissions, and outcomes.
• Ensure compliance with payer guidelines, company policies, and regulatory requirements.
• Communicate with insurance companies, TPAs, and internal stakeholders regarding claim status.
• Prepare daily, weekly, and monthly reports on submission activities and rejection trends.
• Escalate complex or recurring issues to the Team Lead or Manager.
• Participate in quality improvement initiatives to reduce rejection rates.

Required profile

• Bachelor's degree or diploma in Healthcare Administration, Medical Records, Business Administration, or a related field.
• 1–3 years of experience in medical claims submission, revenue cycle management, or healthcare operations.
• Familiarity with insurance claim processing and payer requirements (preferred).

Required skills