Job Summary
To support the Head of Medical Claims in the Medical Department by providing operational support in the Medical Department processes. To process and settle insurance claims in a fast, fair and courteous manner to ensure customer satisfaction, company profitability and good corporate image
Job Description
Claims vetting and approval
Receiving and registering incoming claims.
Claims adjudication.
Analysing all patients’ claims (In terms of completeness and validity) and processing them for payment.
Examining and confirming member benefits, entitlements and exclusions.
Preparing member statements (on request) for clients regarding their policy benefit utilisation status.
Preparing payment remittances and credit notes where applicable.
Liaising with providers on claims queries.
Prepare management reports.
Customer service, provider negotiations and reconciliation
Handling customer queries (walk-in, phone & e-mail) regarding claims and payments
Assist in reconciliation and attending reconciliation meetings with the providers
Education and Experience Required
Bachelor’s degree in actuarial science, Commerce, Statistics, Economics, Accounting and Health related field.
Diploma in Nursing
COP (certificate of proficiency in Insurance) & ACII will be an added advantage.
At least one year experience in a busy insurance related field.
Strong analytical skills.
Education
Bachelor`s Degrees and Advanced Diplomas: Business, Commerce and Management Studies (Required)
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