APA Insurance: Claims Officer- Vetter
CLAIMS OFFICER – VETTER
DEPARTMENT: Claims Health
SUPERVISOR: Claims Supervisor
LOCATION: Head Office
JOB PURPOSE
The person will be responsible primarily for vetting medical claims for processing into the Health system, identify conditions, procedures and rejection that will facilitate fast processing of claims. Identify claims that do not meet the criteria of APA policy, procedures and medical norms. Responsible for ensuring quality and accuracy of claims processed while maintaining the TAT and production levels necessary for provider and Client satisfaction.
RESPONSIBILITIES:
Coordination and adjudication of all claims received
Vetting of claims in line with APA policy, procedures and benefits to ensure accuracy of processing and TAT.
Processing of claims, as required, to ensure that production levels and TAT are met
Negotiation where necessary of professional fees and charges, including discounts, to control costs
Monitoring, preventing and highlighting medical claims fraud through regular claim audits and reporting.
Follow up with providers for bills, discrepancies in bills and other information that is holding up processing
Meeting service providers to ensure compliance on contract terms, on use of agreed systems and on agreed tariffs
Answering Client enquiries on claims through e-mail, phone or directly
Reconciliation of provider accounts
Supervising, training and mentoring claims teams to achieve high standards and maintain high motivation and productivity
Preparation of claim reports to Management as required
Filing of Claims processed, as required
ACADEMIC QUALIFICATIONS
Degree holder and/or Diploma in Insurance, Health management , Nursing or other health related fields like Pharmtech, Labtech
EXPERIENCE
At least 3 years’ experience in Health claim processing in a busy environment and/or at least 2 years’ experience in a medical field
SKILLS & ATTRIBUTES
Integrity and honesty
Able to manage tight deadlines
Attention to detail and to following processes
Excellent written and spoken communication skills
Skill in Computer use and reporting
Willingness to train and share knowledge with others
Willingness to work night shifts and weekends when required
Strong preference will be given to candidates with the above qualifications, skills and experience. If your career aspirations match this exciting opportunity, please submit your application through APA Insurance Career website before 12th August 2018. Only shortlisted candidates will be contacted.
http://www.apainsurance.org/