Department
Health Insurance Services(HIS)
Position Type
Permanent
Experience Required
1 years
Key Responsibilities
The key functions of the role will include but not limited to.
- To timely register new claim submissions from accredited health care providers.
- Track claims through the various subsequent workflows.
- Timely update various claims registers and departmental trackers
- Perform claims reconciliations both between internal workflow stations as well as with the various health care providers.
- Attend to audit & claim queries from healthcare providers.
- Admit all qualifying claims in the claims register immediately on receipt.
- Maintain good business relationship with Health Care Providers and conduct Health Care Provider sensitisation on NHIMA Benefits, Tariffs, and importance of properly filled in claim forms.
- Communicate daily to healthcare providers with claims submission omissions.
- To be able to scan, batch and index claims prior to adjudication.
- To prepare daily, weekly, claims status reports.
- To manage the weekly claims adjudication schedule and submission.
- 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.
Education Requirements
- Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language (ZAQA Certified).
- Diploma in a relevant field (ZAQA Certified).
- Degree in relevant field will be an added advantage (ZAQA Certified).
- More than six (6) Months relevant work experience in a similar role,
- Certificate in management of a health insurance scheme, compensation fund or social security will be an advantage
Required Skills
- Excellent knowledge of marketing and customer service,
- Good oral and written communication skills,
- Must be computer literate with MS Office applications skills,
- Attention to detail, and
- Excellent analytical skills.