Job Description

To process medical claims with a focus on cost control and management of member benefits through vetting and coding of inpatient and outpatient bills and capturing in the company medical business operating system(s).

• Verify, audit, and Vet medical claims for payment for both outpatient and inpatient claims as per the claim’s manual/Standard operating procedure.
• Adhere to the customer service charter manual to ensure compliance with agreed turnaround times
• Prompt reporting of any identified risks during claims processing for mitigation.
• Monitor, prevent, and control medical claims fraud/wastages during claims processing.
• Use of data analytics to review cost and quality of service at medical service providers.
• Hold regular business meetings with service providers to ensure compliance on systems such as smart card systems and agreed tariffs.
• Evaluate preliminary claim information and revert to broker or insured for more information where necessary to ensure that the correct information is documented for ease in processing of member reimbursement claim
• Respond to client inquiries within 24 hours of inquiry.
• Communicate and liaise with medical service providers on the resolution of disputed claims.
• Any other duties assigned by management.

Skills

• Medical Claims Vetting, clinical experience

Education

• Bachelor’s degree in any medical-related field, Diploma in Nursing /Clinical Medicine, or any medical-related field.

How To Apply

Click Here To Apply

Apply before or on 16th Jan 2024