Reporting to the Senior Benefits and Claims Officer, the role will be responsible for the administration of claim submissions once they are sent through from the various accredited healthcare facilities. It will also be responsible for ensuring the submitted claims are paid out within the agreed service level agreements by ensuring timely submission to subsequent workflows and tracking the turnaround times within those workflows.
⦁Daily Receiving and registration into claims register all new claims submissions from accredited Health Care Providers.
⦁Daily batching of all received claims from Health Care Providers.
⦁Documentation and tracking of all claims omissions emerging issues and timely engagement of Health Care Providers and Health Risk Management Unit.
⦁Under guidance of Supervisor, participate in claims movement tracker and preparation of daily and weekly reports.
⦁Measure performance of the various workflow turnaround times against agreed service level agreements.
⦁Manage filing and batching of various claim files.
⦁Participate in weekly claims adjudication schedule preparation and submission.
⦁Participate in claims post payment batching and risk audits in conjunction with Claims Reconciliation and Health Risk Units.
⦁As guided by supervisor, participate in claims scanning and indexing,
⦁Participate in any other claims process roles as demand arises and as guided by the Supervisor,
⦁Conduct any other roles as assigned by the Supervisor.
⦁Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language,
⦁Must have a Diploma or Degree in Healthcare Management or any related field,
⦁Certificate or Diploma in Health Insurance, Compensation fund or any social security being an added advantage,
⦁At least one (1) year working experience in a similar role.
⦁Extensive knowledge of the Insurance industry.
⦁Overall understanding of Health Care provider operations and medicine and treatment procedures.
⦁Financial acumen.
⦁Attention to detail, strong analytical and decision-making skills.
⦁Strong problem-solving and decision-making abilities, and ability to work under pressure,
⦁Good oral and written communication skills.
⦁Proficiency in office applications such as Excel, Word, PowerPoint, and many other relevant applications.
⦁Must have good interpersonal skills.
⦁Must have strong influencing and negotiation skills.
⦁Ability to work with limited supervision and highly organized.
Copyright © . All Rights Reserved. ENCHITO.
Your message has be successfully sent to the
Zambia National Data Center.