Head of Claims & Medical Advisor Career Opportunity – IAA Healthcare

Organisation: IAA
Healthcare
Duty Station: Kampala,
Uganda
Reports to: General
Manager
About US:
IAA Healthcare, the leading
Health Management Organization in Uganda, is part of the International Medical
Group (IMG) that integrates International Hospital Kampala (IHK), International
Medical Centre (IMC) and International Medical Foundation (IMF).
Job Summary: The Head of
Claims and Medical Advisor will supervise the claims team to achieve set
business objectives and oversee the medical claims processes and procedures
through use of effective techniques to achieve the objectives of claims cost
control, operational efficiency while meeting customer service needs for
clients. The Head of Claims will also ensure consistent management of provider
relationships through selective contracting and timely payments.
Key Duties and Responsibilities: 
  • Management
    of the claims process to ensure efficiency in processing of claims as per
    the company medical claims processes
  • In
    charge of the verification and audit of outpatient and inpatient claims as
    per the claims processes to ensure compliance and mitigate risk.
  • Negotiate
    professional fees and hospital charges including discounts to control
    expenditure.
  • The
    incumbent will manage the processing and settlement of all claims, and
    authorize requisitions and reimbursements.
  • Holding
    regular business meetings with service providers to ensure compliance on
    contract terms, use of agreed billing systems and agreed tariff s.
  • Actively
    monitor, prevent and control medical claims fraud by carrying out regular
    audits on the internal and external systems/ processes as well as
    providers.
  • Supervise,
    train and mentor medical claims staff to achieve a high level of
    motivation and productivity by the team.
  • Ensure
    good case management for clients
  • Tasked
    with monitoring and improving claims processing turnaround time, practices
    and procedures
  • Handle
    clients and service provider complaints
  • Conduct
    claims control and analysis
  • Actively
    participate in service meetings within the group and attend staff benefit
    briefing sessions as required
  • Prepare
    regular claims reports to clients, management and advice underwriter
    health on relevant claims findings for medical risk review.


Qualifications, Skills and Experience:
  • The
    applicant must have a Medical Degree with relevant clinical experience
    plus experience in management.
  • Three
    years of experience in medical claims management and underwriting.
  • Possession
    of a Diploma in Insurance and or a degree in Health systems Management/
    Business management will be an added advantage
  • Excellent
    communication and negotiation skills
  • Possess
    excellent public relations and interpersonal relationship skills
  • Extensive
    networking with health service providers and other medical insurers
  • Excellent
    analytical and monitoring skills
  • User
    IT skills in database management and office systems
  • Ability
    to evaluate decisions made in benefit utilization management
  • High
    degree of integrity and honesty
How to Apply:
All candidates should email their
application letters, updated CV, copies of certificates including daytime
telephone numbers to the Head of Human Resources to iaa@img.co.ug
Deadline: 30th April 2018
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