Submission & Resubmission Officer

The Claims Submission & Resubmission Officer is responsible for preparing, submitting, and monitoring medical claims to insurance companies to ensure accurate and timely reimbursement for hospital services.

Coordinate with relevant teams to ensure smooth insurance claims processing and workflow efficiency

Support communication between billing, coding, and insurance departments

Prepare and submit insurance claims for hospital services, ensuring accuracy in coding and patient information

Verify patient insurance eligibility and coverage prior to claim submission

Collaborate with billing and coding teams to ensure claims meet payer requirements

Monitor claim submission status and follow up on pending or unprocessed claims

Respond to insurance provider queries related to claim details

Maintain accurate records of submitted claims and their status updates

Stay updated with insurance policies, regulations, and claim submission protocols

Quality and Safety

Promote and maintain quality standards and support continuous quality improvement initiatives

Comply with safety, infection control, and quality control policies and procedures

Ensure adherence to environmental safety and infection prevention practices

Support clinical audit processes and reporting requirements

Communicate professionally with patients, families, and healthcare staff to obtain or clarify required information

Ensure documentation accuracy and compliance with hospital standards

Participate in training sessions for staff, doctors, and nurses on equipment handling and related processes

Attend departmental programs, hospital committees, and staff meetings when required

Support orientation and training of new employees

Maintain professional knowledge through lectures, seminars, and online learning

Complete all required licensing, certification, and mandatory training within deadlines

Apply knowledge of relevant sciences such as anatomy, physiology, and related technical fields

Comply with all OSH and infection control policies, standards, and procedures

Report OSH hazards, incidents, near misses, and assist in risk assessments

Participate in OSH and infection control training, drills, and awareness programs

Follow safe working procedures and use appropriate personal protective equipment (PPE)

Adhere to emergency and evacuation procedures

Ensure proper waste management practices (reduce, reuse, recycle)

Participate in OSH audits and inspections to maintain standards

Prevention and Control of Infection (PCI)

Adhere to NMC PCI Policy and Strategy at all times

Maintain strict hand hygiene practices, including the 5 moments of hand hygiene

Follow “bare below the elbows” and environmental cleanliness standards