Key Responsibilities

• Post vetting of claims within set benchmarks to ensure they are within scope of cover.
• Authorizing claim payments within the agreed financial limits.
• Generate outpatient claim analysis reports and make recommendations to management on areas of improvement
• Oversee the claims data entry, adjudication and processing of health provider and re-imbursement claims, ensuring data accuracy, completeness, and compliance with regulations.
• Responding to queries raised by service providers and customers within 24 hours and handling claim appeals and resubmissions.
• Ensure all claims for service providers are ready for payment within the set timelines for the specified providers.
• Facilitation of monthly service provider reconciliations with the vetting team within agreed timelines and provided allocation.
• Enhancing good relationship with service providers through excellent customer service.
• Ensuring team work through supervision of assigned staff at vetting level.
• Any other duties that may be assigned thereof.

Skills and Competencies Required

• Knowledge on health insurance benefits
• Knowledge on treatment protocols
• People management skills of both external and internal partners
• Customer Focus
• Continuous Innovation
• Ownership & Commitment
• Team player
• Strong organizational skills
• Basic computer skills
• Excellent communication and multi-tasking skills

Experience, Academic and Professional Qualifications required

• At least 4 years’ experience in healthcare services delivery setup.
• Bachelor’s degree in Nursing, Clinical Medicine or any other medical related field.
• A valid practice license.
• At least 2years experience as a team leader in healthcare services delivery or Medical Insurance setup will be an added advantage.
• Diploma in insurance is an added advantage