HMO Claims Officer at EMEL

Description 

• Examine bills and claims from using the agreed Tariff to ensure authenticity.
• Ensure bills are vetted before sending them to HMOs
• Ensure diagnosis matches with treatment
• Request for both payment advice and schedule from HMOs
• Ensure Authorization codes are received as appropriate for all secondary healthcare
• Ensure the lists of registered enrollees from HMOs are updated or ensure the enrollee's status is verified before treatment.
• Investigate suspicious claims through Enrollee contact, case folder checks and other approved protocols
• Escalate complicated fraudulent claims to the management.
• Forward approved Claims to Clinical Director for review and final approval.
• Participate in the resolution of medical claims cases requiring rigorous negotiations

Requirements

• Interested candidates should possess an HND with 3 - 5 years work experience.