Job Description
• To process, initiate service provider payments and communicate payments statements to service providers
• Timely verification and vetting of all medical provider invoices.
Timely communication of payments to service providers and sharing statements.
Manage benefit utilization and report on the same
• Recommend cover design to underwriter as a result of vetting
• Verify and review all medical claims invoices and provide recommendations on cover design aspects as a result of verification to Underwriting
• Processes documentation all medical claims for settlement and ensures claim files are signed promptly
• Negotiates professional and procedure fees with service provider and ensure fess are within Medical Board rates
Manages administration of outpatient self-funded schemes for specifically allocated schemes as well as benefit utilization management of the same ensuring reports are generated on a quarterly and annual basis to Claims Supervisor and scheme managers
• Gives feedback to underwriting on claims which require future intervention including prompt reporting on fraud cases, overpricing issues and over utilization and liaising with scheme manages and service providers
Follows up recoveries from employers and insured for settlement paid on behalf
• Any other duties assigned by employer

Skills
• Authentication, Communication,
• Computer Literacy,
• Customer Service,
• Documentations, Invoices,
• Medical Claims, Payments,
• People Management,
• Taking Initiative,
• Teamwork,
• Utilization Management,
• Vetting

Education
• Bachelors Degree (B): Medical Claims Assessing (Required), Bachelors Degree (B): Nursing (Required)