In this position, you are required to ensure the completeness and accuracy of all the Insurance Billings on a daily basis, follow up, and submissions of all insurance Claims and rejections.

Main Responsibilities
• Ensure all claims are vetted and audit claims received on a monthly basis.
• Oversee claims daily operations to ensure accuracy and completeness of each patient File.
Ensure that all medical diagnostic related rejections are minimized to a zero percent and a monthly rejection report is submitted to the finance manager.
• Frequently give back to the affiliate doctors/specialist and all other stake holders on Insurance exclusions and limits.
• To be responsible for reconciling disputed claims with the respective doctors.
• To internally source for medical explanations from the respective personalities/officers to be able to explain any claims rejections and assist the credit controller in resubmitting them to the Insurance Companies for payment.
To regularly Liaise with the Insurance Companies and be able to meet and explain any variances in the Claims.
• To perform any other duties that may arise in line with this role or the function it supports and as assigned from time to time.

Key Deliverables
• Assess claim forms daily to ensure proper billing and completeness
• Ensure submission of claims by 5th of every month
• Eliminate rejection of claims to 0%
• Evaluates claims with regards to eligibility
• Coordinates workflow & meet all deadline

Critical Success Factors For The Job

Qualifications & Certifications
• Diploma in Clinical Medicine or bachelor’s in medicine being an added advantage.
At least Three to Five years’ experience as a Claims Officer
• Willingness to work a flexible schedule and fill in when required
• Excellent communication skills
• Proficient computer skills
• Good working knowledge of healthcare Insurance
• Accurate and precise attention to detail
• Ability to work well with management and staff at all levels