Claims Executive at Prepaid Medicare Services Limited

Job Ref: CE-ABJ-01-22

Job Summary

• Manages and administrates direction of billing for medical services provided to patients in order to ensure they receive care in the most efficient manner.
• They work to plan, organize, and direct a medical claims department.
• A healthcare Claims Manager also coordinates with representatives of outside agencies, and members of the public by providing accurate information in an efficient manner.

Key Responsibilities
Include the following:

• Function as an information source through telephonic assistance to members, providers, billings, and various company/department staff.
• Provide pleasant customer experience through superior customer service methods, problem solving and real-time issue resolution.
• Interact with provider community and various departments to resolve issues involving the membership and credentialing status.
• Explain benefits, eligibility status, enrolment processing procedures and status of authorizations and referrals to callers.
• Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls).
• Process complaints, following established guidelines.
• Maintain knowledge of NHIS guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.
• Answer calls professionally and respond to customer inquiries
• Identify and escalate priority issues
• Other duties may be assigned.

Requirements

• Must be a certified Registered Nurse, B.NSc Nursing with 3 to 5 years of experience
• Must be willing to resume work 3 days after interview.
• Must be willing to work 24 hours
• Masters in MPH and MBA is a vital advantage
• Knowledge of the operations of the National Health Insurance Scheme (NHIS) and Health Maintenance Organization will be an added advantage
• Excellent customer relationship skills
• Good communication/presentation skills (both oral and written)
• Ability to communicate effectively in both oral and written English language
• Must be a team player, able to build and maintain effective and collaborative sales and marketing network
• Must be able to take responsibility and demonstrate high level of integrity in dealing with all stakeholders.

Required Skills:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and/or ability required:

• Good Typing Skills
• Attention to detail
• Professional development through participation in continuing education and professional Organizations.
• Good verbal and written communication skills
• Must be Conversant with the HMO processes and Maintenance
• Must also be good in Coordination, Listening, Scheduling and Teamwork
• Must possess good administrative skills
• Superior problem solving skills
• Ability to explain detailed instructions articulately and clearly
• Ability to analyse Information promptly
• Exceptional customer services skills
• Proficient in relevant computer applications
• Knowledge of customer service principles and practices
• Knowledge of call centre telephony and technology
• Relevant product knowledge.