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