Job Description
Process claims: Verify and analyzing medical claims as per scheme scope of cover whilst ensuring strict adherence to set guidelines and timelines.
Manage Costs: Negotiate rates and discounts and monitor trends
Reconcile claims: Ensure claims are paid on time and reconcile with estimates
Follow up on claims: Ensure claims are reimbursed on time, and follow up on outstanding claims
Maintain records: keep records of claims related documents and payment vouchers and provide information to finance department
Reports: preparation of utilization reports and other reports as required by member / client
Communicate with providers: Resolve issues, clarify billing and share information
Claim cost: management through enforcement of agreed tariffs, monitoring claims trend and conducting utilization review
Compliance – Ensure legal compliance of medical claims data in accordance with the Data Protection Act and any other legislative guidelines.
Relationship: Maintain strong working relationship with service providers, Insurance company partners, customers and business stakeholders
MINIMUM POSITION QUALIFICATION REQUIREMENTS
Education Bachelor’s Degree Bachelor of science in healthcare related field RQ
Professional Qualifications Certificate of proficiency in Insurance – COP AA
Master’s Degree Health management OR a Business-Related Field AA
Detail Minimum[1] No of Years Need Type
Claims Processing 1 RQ
Claims vetting 1 RQ
Provider account reconciliations 1 RQ
Medical claims filing 1 DE
go to method of application »
Use the link(s) below to apply on company website.
Apply via :