Job Description:
- Examine Healthcare Providers’ Claims using Tariff agreement to determine authenticity & payment.
- Forward approved Claims to Team Lead for review and final approval.
- Investigate complicated Claims and escalate to the Team lead, if necessary.
- Investigate complicated claims by speaking to Enrollees and providers.
- Update Providers’ dashboards and implement resolutions.
- Decline fraudulent Healthcare Providers’ Claims, and state causative reasons.
- Escalate fraudulent cases to the Committee of Doctors.
Requirements:
- Must be a Registered Nurse/ Midwifery
- Minimum of 2years experience as a Claims Assessor.
- 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.
