Job Title: Voucher Claims Officer
Organisation: Marie Stopes
International (MSI)
International (MSI)
Duty Station: Kampala,
Uganda
Uganda
Reports to: Senior ICT
Officer
Officer
Ref: 006/08/2015
About US:
Marie Stopes
International (MSI) is a global non-profit organisation providing personalised
contraception and safe post-abortion care services to women and girls. Our
local teams of professionals are passionate about the work they do in
communities across 37 countries. The services we provide give a woman the power
to choose when she has children so that she is free pursue her plans and dreams
for herself and her family.
International (MSI) is a global non-profit organisation providing personalised
contraception and safe post-abortion care services to women and girls. Our
local teams of professionals are passionate about the work they do in
communities across 37 countries. The services we provide give a woman the power
to choose when she has children so that she is free pursue her plans and dreams
for herself and her family.
Job Summary: The Voucher Claims Officer will primarily verify
all voucher claims entered into the claims processing platform to support the
timely reimbursement of reproductive health services delivered by the voucher
service providers. The claims processing platform uses unique serial numbers
and barcodes on vouchers along with customized claim processing software to
promote best-in-field voucher management. Claims Officers are expected to
assess the validity of claims from a broader medical perspective and identify
claims with inconsistencies between sound medical practice and services
delivered. The Claims Officers are responsible for technical and in-depth
analysis of each claim in the claims processing system in order to accurately
approve quarantine or reject payment. All decisions taken by Claims Officers must
be medically evidence based and clearly documented in the system. Claims
Vetting Officers are also expected to investigate all quarantined claims
directly with the service provider and gather sufficient evidence to
subsequently approve or reject the claim. Performance will be measured by the
number of claims vetted and the integrity of data input in the system to
support or reject claims. Claims Officers are expected to work in close
collaboration with the finance team, service providers and voucher processing
team to facilitate an effective and efficient payment process.
all voucher claims entered into the claims processing platform to support the
timely reimbursement of reproductive health services delivered by the voucher
service providers. The claims processing platform uses unique serial numbers
and barcodes on vouchers along with customized claim processing software to
promote best-in-field voucher management. Claims Officers are expected to
assess the validity of claims from a broader medical perspective and identify
claims with inconsistencies between sound medical practice and services
delivered. The Claims Officers are responsible for technical and in-depth
analysis of each claim in the claims processing system in order to accurately
approve quarantine or reject payment. All decisions taken by Claims Officers must
be medically evidence based and clearly documented in the system. Claims
Vetting Officers are also expected to investigate all quarantined claims
directly with the service provider and gather sufficient evidence to
subsequently approve or reject the claim. Performance will be measured by the
number of claims vetted and the integrity of data input in the system to
support or reject claims. Claims Officers are expected to work in close
collaboration with the finance team, service providers and voucher processing
team to facilitate an effective and efficient payment process.
Key Duties and Responsibilities:
1.
Provide technical analysis of all claims in the system for approval,
quarantining or rejection of claims.
Provide technical analysis of all claims in the system for approval,
quarantining or rejection of claims.
·
Work closely with service providers to further
investigate abnormal claims from a medical perspective using an evidence-based
approach.
Work closely with service providers to further
investigate abnormal claims from a medical perspective using an evidence-based
approach.
·
Actively monitor for patterns and reoccurrences of
abnormal claims and identify capacity gaps in service provider’s knowledge and
claims reporting.
Actively monitor for patterns and reoccurrences of
abnormal claims and identify capacity gaps in service provider’s knowledge and
claims reporting.
·
Compile and submit vetting reports for the finance
team to guide claims payments.
Compile and submit vetting reports for the finance
team to guide claims payments.
2.
Technical analysis of all claims in the system for approval, quarantining or
rejection of claims
Technical analysis of all claims in the system for approval, quarantining or
rejection of claims
·
Routinely evaluate each claim from a logical,
medical and technical perspective
Routinely evaluate each claim from a logical,
medical and technical perspective
·
Match the cost of claims against services provided
Match the cost of claims against services provided
·
Identify claims with abnormalities for quarantine
and record supporting evidence
Identify claims with abnormalities for quarantine
and record supporting evidence
·
Reject incomplete claims with supporting
documentation
Reject incomplete claims with supporting
documentation
3.
Liaise with service providers to further investigate abnormal claims from a
medical perspective using an evidence based approach
Liaise with service providers to further investigate abnormal claims from a
medical perspective using an evidence based approach
·
Conduct calls or visits to service providers with
quarantined claims to collect further evidence supporting their claims, such as
client records
Conduct calls or visits to service providers with
quarantined claims to collect further evidence supporting their claims, such as
client records
·
Guide providers on submitting future claims correctly
Guide providers on submitting future claims correctly
·
Manage and handle all data with confidentiality and
ensure all data protection mechanism are strictly adhered to
Manage and handle all data with confidentiality and
ensure all data protection mechanism are strictly adhered to
4.
Monitor for patterns of abnormal claims and identify capacity gaps in service
provider’s knowledge and claims reporting:
Monitor for patterns of abnormal claims and identify capacity gaps in service
provider’s knowledge and claims reporting:
·
Compare new claims against historical claims from
providers to uncover repeated incidences of claim issues
Compare new claims against historical claims from
providers to uncover repeated incidences of claim issues
·
Report recurrent issues to a superior with
supporting evidence
Report recurrent issues to a superior with
supporting evidence
5.
Generate vetting reports for the finance team to guide claims payments: Generate
monthly reports for the finance team with clear guidance on which claims to
process for payments and which claims to reject
Generate vetting reports for the finance team to guide claims payments: Generate
monthly reports for the finance team with clear guidance on which claims to
process for payments and which claims to reject
Qualifications, Skills and
Experience:
Experience:
·
The ideal candidate should preferably hold a Diploma
/ Certificate in Midwifery
The ideal candidate should preferably hold a Diploma
/ Certificate in Midwifery
·
At least one year’s work experience in a busy
environment
At least one year’s work experience in a busy
environment
·
Computer literacy skills i.e. proficiency in MS
Office Packages
Computer literacy skills i.e. proficiency in MS
Office Packages
·
Past experience in operating various work-processing
software, spreadsheets, and database programs
Past experience in operating various work-processing
software, spreadsheets, and database programs
·
Prior medical experience, particularly in midwifery
is desirable
Prior medical experience, particularly in midwifery
is desirable
·
Proven ability to maintain high levels of
confidentiality
Proven ability to maintain high levels of
confidentiality
·
Excellent communication skills
Excellent communication skills
·
Good ability to work well in a team
Good ability to work well in a team
The Voucher
Claims Officer is required to demonstrate MSI Uganda’s core values of:
Claims Officer is required to demonstrate MSI Uganda’s core values of:
·
Accountability of all staff to each other and our
clients and stakeholders
Accountability of all staff to each other and our
clients and stakeholders
·
Equality of opportunity and access
Equality of opportunity and access
·
Value for money in the management of our resources
Value for money in the management of our resources
How to Apply:
All suitably
qualified and interested candidates are encouraged to send their electronic
applications including a cover letter, updated CV and academic documents via
E-mail to: [email protected].
qualified and interested candidates are encouraged to send their electronic
applications including a cover letter, updated CV and academic documents via
E-mail to: [email protected].
Deadline: 21st August, 2015
For More
Ugandan Jobs, Please Visit https://www.theugandanjobline.com
or find us on our facebook page https://www.facebook.com/UgandanJobline
Ugandan Jobs, Please Visit https://www.theugandanjobline.com
or find us on our facebook page https://www.facebook.com/UgandanJobline