Claims Assessor at Total Health Trust Ltd

Job Description:

• To vet all claims pertaining to either the managed care or Blue product to ensure that the daily targets are achieved
• To capture all claims pertaining to either the managed care or Blue products to ensure that the daily targets are achieved
• Send out cheques to providers within the agreed SLA
• To ensure all Claims correspondence to providers or members are sent out timeously
• To adhere to and live the organisational values.

Requirements:

• Candidate must be a registered nurse, midwife and possess B.Sc. Nursing
• Additional medical qualification will be an added advantage
• Candidate must have minimum of 4 years post-nursing qualification experience including 2 years in similar role in a Health Maintenance Organization (HMO).
• Candidate must have Clinical experience
• Candidate must have advanced knowledge of NHIS regulatory guidelines, Medical Global Best Practices, Health Insurance, Products and Processes, Claims Processes and Procedures and Scheme Rules.
• Excellent organizational, communication (verbal and written) skills and attention to detail

Other requirements:

• Good organizational and planning capabilities
• Innovative and quick thinking capabilities
• Innovativeness
• Adaptive
• Decision Making skills
• Integrity
• Negotiation Skill
• Adaptive, expertise, Result-Oriented, Relationship Skill
• Working with people
• Strategic
• Must be a good collaborator/Team player