JOB TITLE: MEDICAL CARE ASSESSOR
REPORTS TO: CREDIT CONTROL MANAGER
a) Job Purpose
To review, assess and evaluate the medical care provided to patients to ensure appropriateness, cost-effectiveness, and adherence to clinical standards and policy guidelines. The role ensures that patient care meets the expected quality and complies with payers or regulatory requirements.
b) Main Duties and Responsibilities
- Ensure discharge TAT of less than 2 hours by assessing all patient medical records, treatment notes, and diagnostics results realtime to verify the necessity and appropriateness of care.
- Review inpatient and outpatient care and documentation for clinical accuracy and justification including diagnosis and insurance exclusions.
- Ensure treatments procedures comply with clinical guidelines.
- Evaluate insurance claims for completeness and correctness before approval.
- In liaison with care manager, liaise with insurance companies and other payers on clinical queries.
- Daily ward rounds to monitor standards of care delivered across different departments.
- Participating in clinical audits, hospital surgical package review meetings as well as contributing to overall care improvement programs and initiatives.
- Work with clinicians, billing teams, and claim units to align clinical and financial processes
c) Minimum Requirements/ Qualifications
- Diploma in Nursing from a recognized Institution.
- Valid practicing license.
- At least 2 years’ experience as a general nurse and 1 year in a similar role.
- Insurance training is an added advantage.
- Familiarity with Medical coding. (ICD-10, CPT)
d) Key Job Requirements
- Excellent communication and customer service skills.
- Good interpersonal skills and a team player.
- Flexible and can work under pressure with minimum supervision.
- Desire for personal development, improvement, and learning.
If your background, experience and competence match the above specifications, please send us your application (cover letter & CV/Resume) quoting the job title on the email subject (MEDICAL CARE ASSESSOR), your current and expected remuneration, testimonials and full contact details of 3 referees, to [email protected]. The application should be received not later than 5.00pm on 29th August 2025. We shall ONLY accept ONLINE applications. Interviews will be conducted on a rolling basis. Due to the high number of applications, only shortlisted candidates will be contacted.
