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