preserve exceptional capability to deliver superior value in the quality of products, service and return on investment, and to maintain standards worthy of our proud business tradition
INSURANCE COMPANY OF EAST AFRICA LIMITED Is seeking suitably qualified persons for the following jobs to add value to their business:
Medical Claims Officer
Reports to Claims Manager /Head of Medical Department Purpose of the Role:
The job holder will be responsible for reviewing, auditing medical claims, evaluate pending claims, reconciliation & handling Pre-authorization requests with assuring excellent customer service.
Key Responsibilities:
• Ensuring prompt registration and acknowledgement of newly reported claims.
• Confirmation of medical limits & scope of cover before processing payments.
• Dispatching medical cheques to service providers.
• Assist in implementation of medical claims processes, reconciliations protocols and to communicate & clarify to clients, providers & intermediaries.
• Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures.
• Review and audit medical claims and evaluate pending claims
• Ensuring that outstanding claims are regularly reviewed
• Assist in managing Pre-authorization business to optimize cost efficiencies and subject to medical & policy eligibility.
• Minimize fraud by conducting provider visits, second opinions and profiles. Maintain documentation process in relation to providers
Qualifications and Experience Required:
• Tertiary qualification in the medial/clinical field
• Minimum of 5 years of experience
• Good Customer Relations Skills.
• Computer Literate.
• Analytical, Negotiation, Interpersonal and Communication Skills.
• Must be Cooperative and be able to work well with minimum supervision.
• Ability to Plan, Organize and Prioritize (ability to work within strict deadlines).
• Sound understanding of the medical class of insurance business will be an added advantage
How to apply: If you meet the above criteria and have what it takes to add value to our business, send your application, CV (including 3 referees) and scanned certificates electronically to Maggi Kaddu Consulting Company at mkbaliddawa@qmail.com Deadline for receiving applications – 27th January 2012.
