Jobs at Eden Solutions and Resources Limited

Job Description

• The Claims Officer (HMO) is responsible for processing and adjudicating health insurance claims in a timely and accurate manner.
• This will include verifying coverage, determining eligibility, and processing payments to providers. You will also work to resolve member complaints and investigate potential fraud.

What should you do to be considered successful?

• Process and adjudicate health insurance claims in a timely and accurate manner
• Verify coverage and determine eligibility for members
• Process payments to providers
• Resolve member complaints and investigate potential fraud
• Maintain accurate and up-to-date records of all claims
• Work with other departments to ensure that claims are processed and adjudicated in accordance with company policies and procedures
• Stay up-to-date on the latest changes to healthcare laws and regulations
• Provide excellent customer service to members and providers
• Process payments to seller partner pharmacies, telemedicine and laboratories
• Set up proper claims processing procedures - keeping accurate records of HMO orders, supplies by partner providers, confirm receipts in writing by HMO enrollees and proper submission of claims to HMOs
• Keep proper records of outstanding claims at the providers and HMOs and ensure proper reconciliation
• Ensure on-time payment by the HMOs

What should you have done in your career?

• Bachelor's Degree in a related field, such as Business Administration, Healthcare Administration, or Public Health
• 2+ years of experience in claims processing or a related field
• Must be working in same role at another Pharmacy Benefits Company
• Strong knowledge of health insurance plans and benefits
• Excellent analytical and problem-solving skills
• Ability to work independently and as part of a team
• Excellent communication and interpersonal skills
• Experience with HMO claims processing systems
• Experience with healthcare fraud investigation
• Experience with customer service.

How important are you to the bottom line?

• You play a pivotal role in managing and processing claims efficiently. Your accuracy and effectiveness directly impact customer satisfaction, financial stability, and compliance with healthcare regulations, essential to the overall success of the organization.

Biggest problem solving duty in this role:

• To effectively navigate and resolve complex claims issues, ensuring accurate and timely processing, minimizing disputes, and maintaining compliance with healthcare regulations to uphold customer trust and financial integrity for the organization.

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Description

• Our client is currently seeking an experienced and detail-oriented Auditor to join their team. The ideal candidate will play a crucial role in ensuring the financial integrity and compliance of our school operations.

Responsibilities
Financial Auditing:

• Conduct regular and thorough financial audits to ensure compliance with regulatory requirements and school policies.
• Examine financial statements, accounts, and records to verify accuracy, completeness, and adherence to accounting standards.

Internal Controls:

• Evaluate and strengthen internal control systems to safeguard school assets and prevent fraud.
• Identify areas of improvement in financial processes and make recommendations for enhancements.

Compliance Monitoring:

• Stay abreast of changes in financial regulations and ensure the school's financial practices comply with relevant laws and guidelines.
• Provide guidance to management on regulatory requirements affecting financial operations.

Risk Assessment:

• Assess financial risks and develop strategies to mitigate potential threats.
• Collaborate with relevant departments to implement risk management measures.

Reporting:

• Prepare comprehensive audit reports, highlighting findings, recommendations, and areas of improvement.
• Present audit results to school management and stakeholders in a clear and understandable manner.

Collaboration:

• Work closely with finance and administrative teams to address any issues identified during audits.
• Collaborate with external auditors during statutory audits, providing necessary information and support.

Training and Awareness:

• Conduct training sessions to enhance staff awareness of financial policies, controls, and compliance requirements.
• Provide ongoing support and guidance to staff on financial best practices.

Qualifications

• Bachelor’s Degree in Accounting, Finance, or a related field.
• Professional certifications such as
• ACCA, ACA, or equivalent are highly desirable.
• 5 years of proven experience as an Auditor, preferably in an educational setting.
• Strong knowledge of accounting principles, financial regulations, and internal controls.
• Excellent analytical and problem-solving skills.
• Effective communication skills, both written and verbal.
• Detail-oriented with a high level of accuracy.
• Proficient in relevant software applications, including MS Excel and accounting software

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Summary

• We are looking to hire an efficient Cashier to handle financial transactions. The ideal candidate must have integrity, excellent customer service orientation as well as the ability to pay attention to details and work in a fast-paced environment.

Responsibilities

• Operate cash register and point of sale (POS) systems.
• Process transactions and handle cash with accuracy.
• Provide exceptional customer service by handling customer purchases, complaints and enquiries appropriately.
• Reconcile cash drawers and sales receipts.
• Strictly adhere to company policies regarding handling cash and processing merchandise returns and exchanges.
• Follow due security procedures to prevent theft and maintain a secure work environment.
• Stay informed on the prices of products and services for optimum functionality.
• Bag, box or gift-wrap packages.
• Maintain clean and tidy check out areas.
• Issue receipts, refunds, change or tickets.
• Record and track transactions on balance sheet properly and report any discrepancies.

Requirements

• Basic SSCE educational qualification.
• Minimum of 1-4 years work experience. Previous experience in similar or relevant role is an added advantage.
• Must have basic math skills for accurate calculations and transaction processing.
• Should be polite and service-oriented.
• Must be diligent, accountable and accurate in transactions and record keeping.
• Should possess good communication skills.