Health Insurance Contract and Claims Officer

About the role

The Health Insurance Contract and Claims Officer will manage contracts and claims for HMO and international health insurance schemes, acting as a liaison between the organisation, insurers and patients to ensure efficient processing and compliance.

Key responsibilities

• Negotiate and manage HMO contracts, monitor performance and ensure compliance.
• Evaluate and select international health insurance providers, negotiate terms and maintain coverage.
• Oversee processing of HMO and international claims, resolve discrepancies and improve efficiency.
• Build and maintain relationships with insurers, patients and internal stakeholders, providing customer service.
• Generate and analyse reports on claims, monitor KPIs and ensure regulatory compliance.
• Implement cost‑containment strategies, negotiate rates and educate patients on cost‑effective options.

Required profile

• Bachelor’s degree in Insurance, Risk Management, Finance or related field (Master’s preferred).
• 1‑4 years experience in insurance administration, claims or risk management; healthcare experience preferred.
• Relevant certifications such as PMP, ACA or ACCA are a plus.
• Strong analytical, problem‑solving and professional attitude.

Required skills

• Proficiency with spreadsheets, databases and claims‑management software.
• Data analysis and reporting capabilities.