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Medical Assesor

Closing: Jan 23, 2023

This position has expired

Published: Jan 19, 2023 (18 days ago)

Job Requirements

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Job Summary

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The Medical Assesor will be responsible for assessing medical claims in line with AARs contracts with providers, in order to make decisions whether to authorize, reject or adjust payments invoiced.

The ideal candidate should have a bachelor’s degree in a business related course, Diploma in Nursing or Pharmacy with at least 2 years relevant work experience, ICT Competency, Requires a hands on individual with great people skills, High analytical skills, intuitive and result delivery abilities, Excellent Communication and presentation skills. 

Education, Experience & Competencies

  • Holders of a Diploma or Bachelor’s degree preferable in Nursing or Clinical Medicine
  • Possess at least 2 years relevant work experience.
  • Holder of a professional certification such as: Insurance professional qualification i.e. AIIK or ACII.
  • Possess excellent interpersonal skills, attention to details and a team player


Responsibilities

The Medical Assesor will be responsible for assessing medical claims in line with AARs contracts with providers, in order to make decisions whether to authorize, reject or adjust payments invoiced.

The ideal candidate should have a bachelor’s degree in a business related course, Diploma in Nursing or Pharmacy with at least 2 years relevant work experience, ICT Competency, Requires a hands on individual with great people skills, High analytical skills, intuitive and result delivery abilities, Excellent Communication and presentation skills. 

Education, Experience & Competencies

  • Holders of a Diploma or Bachelor’s degree preferable in Nursing or Clinical Medicine
  • Possess at least 2 years relevant work experience.
  • Holder of a professional certification such as: Insurance professional qualification i.e. AIIK or ACII.
  • Possess excellent interpersonal skills, attention to details and a team player


• Review,assess,code,approve and processing of claims accurately under correct SAMA
and AAR in house tariff codes
• Capture claims master information, claims detail/line information and claims reference information ensuring claim is processed against the right benefit type and that the right scheme rules are applied.
• Detect any fraudulent claims e.g. over pricing of items or services, over-provision of
services and scheme abuse practices.
• Communicate part payments and their reasons to providers in advance through PPO
administrator
• Audit provider billing practices or high quantity drug reports and advice the claims
manager.
• Advise other claims handlers on their cases and act as the focal point for claims requiring medical claims knowledge
• Identify the cost drivers and their trends and inform the claims manager with a view to finding solutions to cost containment
• Respond to internal and external queries in a timely manner
• Attend weekly and other relevant departmental meetings.

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