Benefits & Claims Coordinator

Benefits & Claims Coordinator

Location: Lahore (On-site)

Job Overview

Software Finder is looking for a detail-oriented and highly organized Benefits & Claims Coordinator to manage the end-to-end administration of employee medical benefits, with a primary focus on OPD claims processing. This role is responsible for ensuring timely, accurate, and compliant reimbursement of employee medical claims while maintaining confidentiality and delivering an excellent employee experience.

The ideal candidate has a strong understanding of medical reimbursement processes, excellent documentation skills, and the ability to coordinate effectively with employees, HR, and third-party administrators (TPAs) to ensure seamless claims management.

Key Responsibilities

Manage the complete lifecycle of OPD claim processing, from submission to reimbursement.

Review medical bills, prescriptions, receipts, and supporting documents to ensure compliance with company policies and insurance guidelines.

Verify claim eligibility, documentation accuracy, and reimbursement limits.

Coordinate with employees regarding claim submissions, missing documentation, and claim status updates.

Liaise with insurance providers and third-party administrators (TPAs) to facilitate smooth claims processing and issue resolution.

Maintain accurate employee medical records, OPD utilization reports, reimbursement trackers, and medical balance records.

Ensure claims are processed within defined service level agreements (SLAs).

Support the implementation, communication, and administration of employee health benefits and OPD policies.

Prepare monthly and quarterly reports on claims utilization, reimbursement trends, and benefits data.

Assist with internal audits and ensure compliance with company policies and regulatory requirements.

Identify discrepancies, duplicate submissions, or potentially fraudulent claims and escalate them appropriately.

Continuously recommend and implement process improvements to enhance claims tracking, reporting, and operational efficiency.

Maintain strict confidentiality while handling employee medical and personal information.

Requirements

Bachelor's degree in Business Administration, Human Resources, Healthcare Management, or a related field.

1–3 years of experience in medical billing, OPD claims administration, employee benefits, or healthcare reimbursement.

Strong understanding of health insurance, OPD reimbursement policies, and claims processing procedures.

Excellent attention to detail with strong documentation and record-keeping skills.

Proficiency in Microsoft Excel and experience using HRIS or claims management systems.

Strong analytical, organizational, and problem-solving abilities.

Excellent written and verbal communication skills.

Ability to manage multiple claims simultaneously while meeting deadlines.

High level of integrity and ability to handle confidential employee information with discretion.

Preferred Skills

Experience working with corporate health insurance providers or Third-Party Administrators (TPAs).

Familiarity with employee benefits administration and healthcare compliance practices.

Knowledge of medical billing terminology and reimbursement documentation.

Experience preparing claims reports, dashboards, and utilization analytics.

Ability to identify process improvement opportunities and optimize claims workflows.

Strong stakeholder management and cross-functional coordination skills.