MEDICAL CLAIMS AND CASE MANAGEMENTMOFFICER
Job purpose/ Objectives
- To prudently manage medical claims processing in order to achieve efficiently payable medical claims.
- To process claims in an efficient and cost effective manner to ensure customer retention and business growth.
- To comply with internal, statutory and industry compliance requirements in order to protect Company interests.
- To develop and maintain competency and motivation to meet departmental objectives.
Job Roles
- Register and Verify Medical claims before payment.
- Respond to all enquiries from Insureds and providers about medical Insurance services.
- Review and respond to Pre-authorizations.
- Manage reconciliation of invoices from Service Providers and other claimants to facilitate settlement on a monthly basis.
- Review and Negotiate prices with service providers to achieve cost efficiency and effectiveness.
- Maintain up to date records and files of claims.
- Periodically Visit and inspect Service
Providers’ Premises to ensure appropriateness of services. - Access Proposals and manage service provider recruitment process.
- Monitor quality of service provided by Medical service providers.
- Visit patients, Review and give opinion on Patient’s alternative quality and cost efficient Treatment.
- Coordinate with different specialists and consultants to review patients’ conditions and management.
- Maintain an updated list of Service Providers.
- Review and analyze claims trends, identify risky accounts and high cost providers and provide guidance on the management of loss ratios.
- Prepare weekly reports and attend claims review meetings for both providers and clients.
- Sharing wellness updates/newsletters and clients’ sensitizations.
- Promote Team work and assist in any departmental activity and any other duties arising thereof and as directed by superiors from time to time.
Core Competencies
- A diploma in clinical Medicine or Nursing or its equivalent.
- Confidentiality of Medical records.
- Ability to negotiate with and maintain healthy relationships with clients and service providers.
- Computer literacy: Ms. Word/Excel.
- Good communication skills (written and oral).
- Strong problem solving skills and attitude.
- Well-developed interpersonal skills.
- Able to work under minimum supervision.
- Great presentation skills.
Education and Experience
- Minimum of a Diploma in clinical Medicine/Nursing or its equivalent. A Bachelor’s degree in Nursing is an added advantage.
- At least 3 years’ experience in Medical claims and Case management.
HOW TO APPLY
All interested candidates should email their covering letter (maximum 2 pages), current CV and academic documents in one pof file to [email protected] by 17th January, 2025 at 5:00pm.
Only shortlisted candidates will be contacted.
Please include Medical Claims and Case Management Officer in the subject line of your email and ensure that in your covering letter you have included the following;
- Why you are interested in the job
- How you think your experience and skills match the job description
- List your current and expected salary/benefits
- Your daytime contact number and available start date
