Claims Officer - Locum

Requirements

• Diploma or Degree in Nursing or equivalent.
  
• Proficient in MS Office Suite
  
• Formal training in customer care or equivalent demonstrated experience
  
• A minimum of 3 years’ experience in a busy Hospital or Insurance
  

• Verify and vet Medical Claims for both outpatient and Inpatient claims as per the claims Manual/standard operating procedure.
  
• Adhere to customer service charter Manual to ensure compliance to agreed turnaround times.
  
• Prompt reporting of any identified risk during claims processing for mitigation.
  
• Evaluate Preliminary claim information and revert to corporate clients for more information where applicable.
  
• Monitoring of invoices returns and taking appropriate action within a week from the date of return on clinical issues and any query.
  
• Take the lead in ensuring the reasons for returns are well addressed to avoid future recurrence.
  
• Preparing Rejection analysis on clinical issues and monthly reports as a tool to guide the institution on the status of control.
  
• Work with dispatch section to ensure all invoices have been dispatched after Verifications
  
• Work with Debtors team to review all the Clinical issues within the reconciliation for signoff for the agreed period with corporate clients.
  
• Filing of Claim forms for Diagnosis on reconciliations and maintaining accurate departmental reports on Clinical issues.
  
• Facilitate closures to all rejected invoices on medical issues.
  
• Participate in all team efforts as departmental needs arise.