Assistant Manager Health Claims At Britam

Details of the offer

Job Purpose:
Overall managing medical claims processes and procedures through the use of effective techniques to achieve the objectives of claims cost control and operational efficiency.

Key responsibilities:
Oversee the claims process flows to ensure efficiency in processing of claims as per the company medical claims procedure manuals.
Verification and audit of outpatient and inpatient claims as per the claims manual and customer service charter manual to ensure compliance and mitigate risk.
Oversee processing and settlement of medical claims.
Hold regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs.
Prepare scheme by scheme and portfolio performance reports.
Quality Assurance, develop review and implement quality assurance principle for Inpatient and Outpatient claims.
Oversee automation of all claims processes and use of AI and Machine learning.
Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers.
Supervise; train and mentor medical claims staff to achieve a high level of motivation and productivity by the team.
Prepare regular claims reports to clients, management and advice medical underwriting section on relevant claims findings for medical risk review.
Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, experience and qualifications required:
Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
Professional qualification in Insurance (ACII, FLMI or IIK).
6-8 years' experience in medical claims handling two of which should be in a supervisory position in a busy insurance office.
Knowledge of insurance concepts.


Nominal Salary: To be agreed

Source: Myjobmag_Co

Job Function:

Requirements

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