Organization: IAA Resolution
Duty Station: Kampala, Uganda
About IAA:
IAA-Resolution, which
is a partnership between IAA Healthcare and Resolution Health East Africa,
offers healthcare packages that provide our clients with high value in benefits
and unique service. IAA- Resolution has a strong accredited medical
service provider network of over 500 hospitals, clinics and doctors all across
East Africa. We also provide access to over 750 health hospitals
and clinics in East Africa and South Sudan to the over 106,000 members who
entrust us with their healthcare security.
is a partnership between IAA Healthcare and Resolution Health East Africa,
offers healthcare packages that provide our clients with high value in benefits
and unique service. IAA- Resolution has a strong accredited medical
service provider network of over 500 hospitals, clinics and doctors all across
East Africa. We also provide access to over 750 health hospitals
and clinics in East Africa and South Sudan to the over 106,000 members who
entrust us with their healthcare security.
Job Summary: The Customer Care and
Claims Coordinator will serve as the liaison to ensure that all relevant
communication and authorisations for medical services to the members are
seamlessly executed to ensure member satisfaction and client retention. The
incumbent will also ensure that all claims received within the department
adhere to the company’s regulations and are accurately processed into the
system for payment. The jobholder will be expected to demonstrate leadership and
professionalism and perform all duties in accordance with the organization’s
policies and procedures, keeping in mind the overall business objectives.
Claims Coordinator will serve as the liaison to ensure that all relevant
communication and authorisations for medical services to the members are
seamlessly executed to ensure member satisfaction and client retention. The
incumbent will also ensure that all claims received within the department
adhere to the company’s regulations and are accurately processed into the
system for payment. The jobholder will be expected to demonstrate leadership and
professionalism and perform all duties in accordance with the organization’s
policies and procedures, keeping in mind the overall business objectives.
Key Duties and
Responsibilities:
Responsibilities:
1. Care Management:
- Cordially answer clients (internal and
external) and providers queries on policy benefits details including but
not limited to balances, providers they can access and coverage details in
a timely manner - Coordinate outpatient undertakings for
clients without membership cards or those missing on the active list in
hospitals. - Coordinate referrals for clients and track
delivery of the same. - Coordinate member post-discharge follow up
calls to check on their progress, any additional service requirements and
provide any additional support. - Log help desk interactions and forward to
relevant persons to assist depending on the query type. - Generating outpatient reports which
include dental, optical, referral and outpatient quarterly reports to
compare on the quarter budgets and presenting to the department. - Plan, prepare and budget for care packages
and prepare relevant documentation for the same - Ensure prompt filing and efficient
retrieval of reports and any relevant documentation.
2. Claims Receiving:
- Sort, stamp and verify received claims and
invoices into outpatient, inpatient, refunds and resubmissions. - Manage the front office, make/place calls
and assist walk-in clients - Maintain a record of claims delivered.
3. Documents Management:
- Scan all received claims and
documentation. - Index the captured claims in the DME
application.
4. Claims Capture:
- Accurate and timely capture of Claims in
the company’s Management Information System. - Ensure timely submission of claims to the
adjudicator for final vetting before dispatch.
5. Reporting:
- Prepare claims reports for analysis and
decision making. - Perform any other duties assigned by the
Manager.
Qualifications, Skills and
Experience:
Experience:
- The candidate should possess a diploma in
a relevant field. - At least 6 months – 1 year relevant work
experience. - Excellent customer service and PR skills
- Excellent communication and interpersonal
skills - Good negotiation and problem solving
skills - Possess the ability to work responsibly
with or without direct supervision.
How to Apply:
All candidates should send their electronic application to:
[email protected] consisting of your application letter and updated CV
listing three references, quoting the position in the email subject.
[email protected] consisting of your application letter and updated CV
listing three references, quoting the position in the email subject.
Deadline: 8th August 2014 by 5PM
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