Customer Services Officer - Health

Description

EFU Life Assurance Ltd. is seeking a diligent Customer Services Officer - Health to ensure excellent support and service in the health insurance domain. This role involves visiting network hospitals, verifying admission cases, and handling non-panel case verification with a focus on customer satisfaction. The ideal candidate has at least one year of experience and strong skills in hospital networking and admission case verification. You will act as a key liaison between the hospital and our company to address customer issues and verify services provided under health insurance coverage. This position does not involve team management but requires effective communication and coordination with hospital staff and internal supervisors to resolve customer concerns swiftly and accurately. In this role, you will regularly assess admitted patients’ files to verify medical necessity and coverage limits, identify unnecessary admissions, and report findings to your supervisor. You will monitor and verify billing issues daily and work closely with network and non-network hospitals in the city and nearby locations. Your attention to detail and problem-solving skills will contribute to improving customer services and ensuring compliance with company policies. This position demands proactive engagement with hospitals to guarantee customer satisfaction and smooth operations in health insurance claim verification.

Responsibilities

• Visit assigned network hospitals and other hospitals as necessary to support customer service operations.
• Assess patient admissions by verifying the insured’s identity using valid CNIC documentation.
• Document and report any customer problems or difficulties encountered in hospitals to the Head Office promptly.
• Review admitted patients’ files, including medical notes and bills, to assess medical necessity, investigations performed, coverage scope, and insurance limits in consultation with the supervisor.
• Identify and report unjustified or unnecessary hospital admissions to the supervisor for further action.
• Monitor billing issues daily and communicate the verified bill amounts to the supervisor.
• Verify claims for admitted patients at non-network hospitals within the city and nearby cities to ensure claim validity.
• Maintain consistent communication with hospital staff and internal teams to facilitate effective claim and admission management.
• Ensure compliance with company policies related to health insurance coverage and customer service processes.
• Continuously provide feedback to improve hospital networking and customer satisfaction initiatives.

Experience

1 Year

Apply By

Dec 3, 2026

Required Skills

• Hospital Networking
• Admission Case Verification
• Non Panel Case Verification
• Customer Satisfaction
• Medical Documentation Review
• Claims Verification
• Customer Service

Nice to Have Skills

• Billing Monitoring
• Communication