The Ugandan Jobline

• 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.

• 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

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