The main role of the job holder will be provision of daily supervision and support to claims staff and ensuring that Claims Management standard operating procedures are adhered to at all levels. The role will be the custodian of the end to end Claims Management Process flow and mandated to ensure that submitted claims are paid out within the agreed service level agreements.
• Provide daily support to claim staff on claims management and filing activities;
• Ensure that claims team follows Authority regulations and standard operating procedures;
• Develop best practices to optimize claim processing quality;
• To resolve all queries from members and health care service providers in line with agreed Service Level Agreements;
• Ensure timely claims and finance reconciliation in close collaboration with HCP Liaison and Finance department;
• Timely review post adjudication claims and in close collaboration with Manager Benefits & Claims, timely prepare and approve payment requisition schedules according to set timelines;
• To review case management files and ensure these are as per NHIMA guidelines
• To review all claims, identify risks and ensure processing of all claims is done as per Authority Policy;
• To monitor and mitigate frauds and fraud risk within the NHIMA eco system;
• Prepare ad-hoc, weekly/monthly and as required claims status report; and
• To perform any other role as may be assigned from time to time.
Knowledge, Skills, Qualifications and Experience
• Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including; Mathematics and English Language;
• Diploma in Clinical Health related field;
• First Degree, from a recognised tertiary institution is an added advantage; and
• Health Insurance, Compensation fund or social security will be an advantage.
Competencies required for this Role
• 3-5 years of experience in a similar role in an Insurance or Social security industry;
• Good understanding of claims and benefits processes and controls;
• Good oral and written communication skills;
• Good appreciation of MS Office applications;
• Attention to detail;
• Excellent analytical skills; and
• A valid driving licence.
To apply for this job please visit careers.nhima.co.zm .