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Thursday, September 16, 2010

Madison Assistant Claims Manager - Medical Insurance Vacancy

Primary responsibility

To be responsible for medical claims management process including reviewing the same in line with changing business needs, market practices and regulatory requirements.

Key responsibilities
  • Review and implement guidelines as pertains to vetting of all medical insurance claims to ascertain admissibility.
  • Approve the preauthorization, handle case management, retrospective review and discharge planning.
  • Authorize and process payments to providers in line with the service level benchmarks.
  • Processing the inpatient, optical and dental claims as well as adjudicating the outpatient claims for upcountry providers.
  • Review and monitor on monthly basis the credit levels with service providers.
  • Reduce the cost by negotiating rates with providers, monitoring patients expenditure and holding Health talks for scheme members.(thereby lowering the loss Ratio)
  • Conduct monthly service provider audits to ensure performance within the service level agreements and compile reports thereof
  • Supervision of staff to ensure optimum utilization, monitor their performance, determine their training needs and coordinate their training.
  • First university degree
  • ACII/AIIK qualifiers or will have completed their ACII/AIIK by the end of this year
  • Sound knowledge in Medical insurance business including processes & systems
  • Knowledge in industry practices in Medical Insurance Claims
  • Ability to provide guidance and leadership
  • At least four years experience at supervisory level in Medical Insurance Claims.
Interested and qualified candidates are invited to send their application letters together with detailed curriculum vitae indicating their daytime telephone contacts by 24th September 2010 to:

Only short listed candidates will be contacted.

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