Claims Executive at International Health Management Services (IHMS)

Job Description

• Receives and registers claims
• Input vetted claims and prepares them for approval
• Forward approved Claims to Team Lead for review and final approval
• Receives and registers encounter data
• Assisting the claims manager in preparing payment analysis for claims on the NHIS and private scheme
• Respond to queries and concerns relating to the claims department
• Decline fraudulent Healthcare Providers’ Claims, and state causative reasons
• Escalate fraudulent claims to the Head of the Department
• Investigate complicated Claims by speaking to Enrollees and providers
• Investigate complicated Claims and escalate to the Team lead, if necessary.

Qualifications and skills

• Must be a registered Nurse/Midwifery
• Minimum of 2 years experience as a Health Insurance Claims Assessor
• HMO Experience in a similar role is an added advantage
• Excellent numeracy, analytical and problem-solving skills
• Strong ability to make a judgment on medical/surgical cases in relation to enrollee’s benefits
• Ability to make a professional judgment on coverage and non-coverage of care requests per time
• Excellent interpersonal and communication skills