About the job
Purpose of the Job
Develop and oversee the claims management strategy for healthcare business that ensures medicalclaims management is in line with the business strategic plan.
Duties and Responsibilities
- Develop policies and procedures that guide the management of medical claims to ensure compliancewith the specific client’s service level agreements as well as insurance regulations.
- Develop processes for claims management to support efficiency and effectiveness – Processing andPayment of claims to all providers in line with the standard service agreement as well as thecontractual agreement therein.
- Claims Review and Approval – Review claims processed to ensure that all claims fall within scope ofrespective medical insurance policy and comply with claims management policies and procedures.
- Attend to escalated and complex medical claims to ensure these are attended to in a timely manner,and that they do not expose the business to any risk.
- Risk Supervision – Overall process management to shield the company from any potential liabilityemanating from claims processing.
- Business Advisory – Monitor and review claims trends and provide necessary advisory to thebusiness for decision-making, innovation, and strategy review.
- Claims Records management & Reporting.
- Continuous process Audit and Fraud management
- People Management – Develop staff by sharing knowledge, mentoring, coaching, and training and toensure full range of performance management processes and procedures.
- Degree in Nursing, Clinical Medicine or Pharmacy
- Professional qualification in Insurance (AIIK or ACII) will be an added advantage.
- 7 years in health insurance operations 3 of which must be in a managerial role.
- Knowledge of insurance industry and concepts
- Knowledge of insurance regulatoryrequirements
- Formulation of strategies and concepts
- Business management skills
- Strong personality with interpersonal sensitivity
- Leadership skills
- Quality decision making skills.
- Listening skills
- Conflict handling skills
- Presentation skills
- Good written and verbal communication skills
- Team player
- Strong negotiation skills
- Creative & open-minded
- High level of numeracy and strong analytical skill
Method of Application
How to Apply
Interested candidates who meet the above qualifications to send their applications to email@example.com
Please indicate the job title as the subject. Only shortlisted candidates will be contacted.