Claims Officer/Care Cordinator at Box and Cedar

Job Description:

• Analysing and processing of NHIS fee-for-service claims
• Checking enrollee status and approval
• Vetting bills according to NHIS tariff
• Noting discrepancies on the bills and writing or return of claims to affected provider
• Posting of issued cheques for paid claims
• Attachment of bill analysis to paid claims
• Filing of all paid claims
• Computerized processing of NHIS data.
• Assisting in processing NHIS capitation
• NHIS registration of enrollees
• Visitation of NHIS providers / parastatals
• Documenting / imputing of NHIS primary providers bank details
• Giving of approvals to secondary providers for NHIS enrollees
• Payment of NHIS providers capitation to banks
• Notification through correspondences and calls to NHIS providers on payment of capitation to their bank account
• Filing acknowledgement copies/receipts of capitation
• Attending to calls on NHIS enrollee providers
• Attending to NHIS enrollee complaints on omission of names or changes in ID cards (Registration)
• Assisting in enrollee enlightenment on the operation of NHIS
• Answer call professionally.
• Respond to customer enquiries.
• Research required information using available resources.
• Handle and resolve customer complaints.
• Provide customer with product and services information
• Enter customer information
• Accept/process orders, forms and applications
• Identify and escalate priority issues
• Route calls to appropriate resource
• Follow up customer calls where necessary
• Complete call logs
• Produce call reports
• Maintain complaints file (NHIS)
• Resolves enrollee complaints in Hospitals.
• Proffer referral centre and codes when necessary to providers.
• Proficient in relevant computer application.
• Other duties as assigned

Minimum Qualification:

• Nursing, RN, RM

Knowledge & Skills:

• Possess good verbal and written communication skills.
• Listening skills
• Problem solving
• Customer service orientation
• Organizational skills
• Attention to detail
• Initiative
• Adaptability
• Team work
• Stress tolerance
• Resilience.

Job Type:
Full Time

Experience:
2 Years