Job Title: Claims Officer
Organisation: City
Medicals Limited
Medicals Limited
Duty Station: Uganda
Reports to:
Finance and Accounts Manager
Finance and Accounts Manager
About US:
City Medicals is a
highly specialized Medical Service provider that offers pre-deployment and
routine medical check-ups, on-site and remote-site medical services,
international vaccination, travel medicine, DNA testing, highly quality
diagnostic tests, occupational medicine, tropical and infectious diseases,
surgery, admission and dental services.
highly specialized Medical Service provider that offers pre-deployment and
routine medical check-ups, on-site and remote-site medical services,
international vaccination, travel medicine, DNA testing, highly quality
diagnostic tests, occupational medicine, tropical and infectious diseases,
surgery, admission and dental services.
Job Summary: The Claims Officer is primarily responsible
for receiving, identifying, vetting, verifying and taking all insurance clients
through the relevant checks at the point of giving service, ensuring that
services offered are within the patient’s limits of cover and bridging all gaps
that will otherwise lead to loss of funds by the institution in Hoima
for receiving, identifying, vetting, verifying and taking all insurance clients
through the relevant checks at the point of giving service, ensuring that
services offered are within the patient’s limits of cover and bridging all gaps
that will otherwise lead to loss of funds by the institution in Hoima
Key Duties and Responsibilities:
Vetting: As the Claims Officer you will:
- Ensure that patients are covered for services being offered through
checking finger prints, card validity and card ownership. - Ensure patients are treated within their limits of cover
- Ensure that City Medicals does not treat expired/ineligible members.
Pre-authorisation
Seeking
Seeking
- Ensure to seek authorization for procedures, admission, ambulance
pickups/drops before the service is provided or given to the patient. - Ensure receipt of documented authorizations from all insurance
partners through emails or hand-written letters. - Attaching approvals on every claim that requires authorization
before submission to the claims office in Accounts.
Customer Service/Care
- As the Claims officer you will be responsible for ensuring that
insurance patients are well received, are given all the necessary
information relating to their treatment, cover and are smoothly taken
through the system (hospital) with minimum setbacks. - Ensuring good customer care by all the team members
Billing/smarting/tracksoling,
- Ensure all services are billed using the different billing systems.
i.e. Tracksol, Smart, AAR, Sancare etc. - For all claims billed off system a reimbursement should be sent and
the authorizing person indicated.
Checking claim
forms.
forms.
- As a Claims Officer, you will have to go through the claim forms
daily and see if they were properly billed and if they were fully filled
and finalized as follows: - Claims date
- Employee company /employer
- Employee name
- Patient phone number
- Diagnosis
- Key symptoms
- Proof of authorizations attached
- Services itemized and each billed individually
- Claims billed
- Signature : Patient & Doctor
Preparation of
claim forms
claim forms
- All claim forms must be posted and excelled for proper record
keeping and reconciling.
Others
responsibilities.
responsibilities.
- To always make sure that the insurance work station is kept clean
and tidy. - Always account for equipment received from the head of department.
- Attend all insurance team meetings as may be communicated by the
head/supervisors. - Any other duties as may be assigned by the supervisors.
Qualifications, Skills and Experience:
- The ideal candidate must hold a Bachelor’s Degree in Accounting and
Finance. Bachelor’s Degree in Nursing - At least five years’ experience as a Claims Officer
- Willingness to work a flexible schedule and fill in when required
- Excellent communication skills
- Proficient computer skills
- Confidentiality.
- Good working knowledge of healthcare Insurance
- Accurate and precise attention to detail
- Ability to work well with management and staff at all levels
How to Apply:
All suitably
qualified candidates are required to submit a cover letter, CV, copies of
academic certificates/transcripts, 3 competent referees to the Human Resource
Manager, City Ambulance on Email: [email protected]
qualified candidates are required to submit a cover letter, CV, copies of
academic certificates/transcripts, 3 competent referees to the Human Resource
Manager, City Ambulance on Email: [email protected]
Deadline: 1st March 2019 by 5:00pm
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