JOB PURPOSE
Analyzing of medical claims and to ensure the smooth flow of work in line with the departmental requirements to achieve overall business objectives.
PRINCIPAL ACCOUNTABILITIES
Ensuring daily recording of incoming medical bills.
Receiving claims and checking corresponding policies in line with the claim.
Reconciliation of Medical service providers accounts.
Registration of claims and reserving adequate estimates.
Ensuring the ailment is covered under the policy.
Ensuring the treatment and the drugs dispensed are in line.
Ensuring the with-holding Tax by Doctors' is complied with before cheque dispatch.
Ensuring the appointment of investigators for authenticity of questionable claims.
Ensuring the facility is registered within the medical practitioners and dentists board.
Preparing claim notes for vetting by the medical personal and approval/comments by the HOD.
Ensuring dispatch of discharge voucher to the client and communicating by writing on the liability.
Ensuring claims are settled within approved company guidelines
Ensuring proper dispatch of settlement cheques.
Ensuring that the files are sent back to the filling room.
Reconciling of claim statements from stakeholders for correct position of their accounts
Preparing remittances for any Medical claims cheques before dispatch.
Ensuring proper records of outgoing settlement cheques to various stakeholders.
Ensuring service providers meet agreed service timeline.
Ensuring customers service to both internal and external
And any other duties assigned
MINIMUM QUALIFICATIONS - KNOWLEDGE AND EXPERIENCE
Undergraduate Degree in any Related Field
AIIK
CPA
At least 2 years of relevant experience