Job Overview
KSM MANAMENT CONSULTANT, the largest HR firm in Zambia recently acquired GOZAMBIAJOBS.CO.ZM becoming the largest recruitment platform in the country and is now actively looking to recruit an experienced. SENIOR CLAIMS OFFICER, for a client in the Medical Insurance Industry.
Purpose of the Job
To process medical claims/bills submitted by Health Care Providers while applying medical cost containment systems and to maintain reconciled HCP and client accounts
Duties and Responsibilities
- Develop procedures and guidelines for the validation and processing of medical claims/bills and to help medical cost containment;
- To oversee the validation and processing medical claims/bills from HCP as per established procedures and guidelines in a timely manner;
- Prepare and submit monthly, quarterly, annual and ad-hoc claims/billing validation and reconciliation reports;
- In conjunction with the Client Liaison Officer and Health Specialist, maintain an updated record of associated HCP and applicable medical services and pricing schedules, client health/medical policy documents, coverage and register of beneficiaries;
- In conjunction with the Accounting Officer responsible for claims and the Client Liaison Officer, provide information to clients on funds utilization and HCP on beneficiaries and medical coverage to facilitate only authorized access to medical facilities and procedures
- In conjunction with the Accounting Officer responsible for claims and the Client Liaison Officer, ensure that there is adequate deposits in client accounts at all times to pay claims/bills by HCP that might become due in the next scheduled payment period;
- Contributing to the setting of departmental targets and budgets
- Providing support and advise to the Client Liaison Officer and Health Specialist in designing and implementing programs to facilitate satisfactory performance by HCP and sustained client satisfaction and retention;
- Undertake other Company business and administrative activities as may be assigned by the supervisor
Professional Qualifications
- Diploma in insurance, accountancy, health systems management, business administration or any related field
- 5 years of relevant experience preferably in health sector or insurance
- Member of relevant professional body
- Excellent computer skills – MS Office – Word, Excel, email (essential)
- Knowledge of statistical and quantitative analysis methods
- Knowledge of medical, pharmaceutical & health practices
- Ability to interact with health care professionals
- Ability to maintain confidentiality of information
- Excellent communication skills
- Excellent report writing skills
- Highly motivated, creative and able to work with minimum supervision
- High attention to detail and accuracy
- Team player with excellent interpersonal skills
- Flexible with ability and willingness to learn and operate in a new environment
Method of Application:
Should you closely fit the above requirements and are interested in this position, kindly send your CV to: jobs@gozambiajobs.co.zm / jobs@ksm.co.zm by / before 31st August 2022 clearly stating in the e-mail subject line the POSITION you are applying for or Visit our websites: http://www.ksm.co.zm / www.gozambiajobs.co.zm or Download our Recruitment App from Google Play store search for: RECRUITER KSM.
KSM – WE CONNECT PEOPLE TO JOBS AND JOBS TO PEOPLE.