Submission Officer – Healthcare Claims

About the role

The Submission Officer ensures that all eligible inpatient, outpatient and pharmacy claims are submitted accurately and on time. The role focuses on improving claim quality, reducing initial denials, and coordinating with multiple internal teams to prevent revenue loss.

Key responsibilities

• Submit IP, OP and pharmacy claims with proper medical and technical justification.
• Monitor and resolve QMS queries by liaising with physicians, coding and pre‑authorization teams.
• Collaborate with Insurance Approvals and Claims Re‑submission teams to minimise denials.
• Apply securitising rules and DHA/insurance regulations to avoid technical rejections.
• Track payer behavior, identify defaulting payers and implement corrective actions.
• Maintain KPI records, produce monthly submission reports and ensure turnaround targets are met.
• Educate billing and approval teams on process improvements and documentation standards.

Required profile

• Strong medical background with experience in claims reconciliation.
• Good understanding of insurance industry standards and DHA regulations.
• Ability to work closely with physicians, coding, and pre‑authorization teams.
• Analytical mindset to interpret financial data and mitigate financial risk.
• Excellent communication and coordination skills.

Required skills

• Medical coding
• Revenue cycle management
• Insurance claim processing
• Financial data analysis