Junior Claims Assesor

• Verify and analyze all data on claims/cases and ensure these meet the project objectives as well
  as payer expectations for the various projects.
  
• To send back simple yet detailed feedback to the provider team where claims/cases do not meet
  the project expectations.
  
• To ensure any general trends or inconsistencies noted are reported to the operations and provider
  teams.
  
• Timely assessment of claims and cases submitted by the providers, ensuring the queries raised
  are understood, and following up with the provider team to ensure they are resolved.
  
• Provide support to the customer call center to address medical queries that have been escalated
  to Our Client.
  
• Document and be able to extract, present, or discuss provider practices or disease trends.
  
• Deliver feedback and training aimed at addressing the trends picked from the claims/case
  assessment exercise.
  
• Mapping generic rules to medical services, procedures, drugs and lab tests
  
• Participate in testing and documentation of selected client systems.
  
• To perform all other duties as assigned by the supervisor.
  

Requirements

• Degree / Diploma in Clinical medicine or Nursing.
  
• Good understanding of private and public healthcare delivery.
  
• Have a strong understanding of medical treatment protocols and cost -effective prescribing habits
  in relation to market segmentation.
  
• At least 2 years’ experience in a busy hospital set -up. (Experience in insurance will be an added
  advantage).