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Role Title: |
Medical Claims Analyst – 1 Post |
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Business Unit(s): |
Rwanda |
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Business /Function: |
Medical Claims Analyst |
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Location: |
Rwanda-Kigali |
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Reports To: |
Senior Claims Analyst |
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MDP Level: |
Manager of Self |
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Role Size |
L |
JOB SUMMARY
To ensure prompt processing of medical claims.
PRINCIPAL ACCOUNTABILITIES.
- Manage Claims Ratio as per target
- Use claims tariff during claims payment and signing with providers
- Prompt claims settlement as per agreement with providers
- Reconcile service provider account and close issues arising
- Enhance claims documentation for better adjudication
- Pharmacy claims management
- Smart claims monitoring
- Major provider management
- Contain Optical claims
- Reduce drug cost through implementation of Pharmacy Book
- Claims vetting and adjudication
- Effective communication
- Provider and customer Email management
- Complaints resolution time
- Management of reimbursement Claims
- Compliance to Procedure Manuals
- Ensure complete and efficient implementation of e-Oxygen and its integration with other systems.
- Departmental meeting
- Process reviews yearly
- Individual Performance management
- Report your duties monthly on time (on 5th of the month)
- Any other task as assigned by your Line Manager
Qualifications and experience
- University degree in health-related field
- Basic Insurance qualification
Skills and competencies
- Good communication and negotiating skills
- Good attention to details and accuracy
- Good analytical and monitoring skills
- User IT skills in database management and office systems.
- Good interpersonal skills
- Thorough understanding of policy covers/wordings and their interpretation as pertaining to claims
Integrity and honesty
Please visit our careers page through:
Interested candidates are requested to submit their applications by 5.00 p.m. 1st October 2024.
Applicants must possess or be in the process of applying for a POLICE CLEARANCE CERTIFICATE as at the time of making an application.
ONLY short-listed candidates will be contacted.
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