• 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.

• Grade twelve (12) School certificate with 5 ‘O’ levels with a credit or better including; Mathematics and English Language;

• Diploma in Clinical Health-related field;

• First Degree, from a recognized tertiary institution is an added advantage; and

• Health Insurance, Compensation fund or social security will be an advantage.

• 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.