Key Responsibilities<\/p>\n
The key functions of the role will include but not limited to.<\/p>\n
To timely register new claim submissions from accredited health care providers.
\nTrack claims through the various subsequent workflows.
\nTimely update various claims registers and departmental trackers
\nPerform claims reconciliations both between internal workflow stations as well as with the various health care providers.
\nAttend to audit & claim queries from healthcare providers.
\nAdmit all qualifying claims in the claims register immediately on receipt.
\nMaintain good business relationship with\u00a0\u00a0Health\u00a0Care Providers and conduct Health Care Provider sensitisation on NHIMA Benefits, Tariffs, and importance of properly filled in claim forms.
\nCommunicate daily to healthcare providers with claims submission omissions.
\nTo be able to scan, batch and index claims prior to adjudication.
\nTo prepare daily, weekly, claims status reports.
\nTo manage the weekly claims adjudication schedule and submission.
\nParticipate in any other claims process roles as demand arises and as guided by the Supervisor.
\nConduct any other roles as assigned by the Supervisor.<\/p>\n
\u00a0<\/p>\n
Education Requirements<\/p>\n
Grade twelve (12) School certificate with 5 \u2018O\u2019 levels with credit or better including Mathematics and English Language (ZAQA Certified).
\nDiploma in a relevant field (ZAQA Certified).
\nDegree in relevant field will be an added advantage (ZAQA Certified).
\nMore than six (6) Months relevant work experience in a similar role,
\nCertificate in management of a health insurance scheme, compensation fund or social security will be an advantage<\/p>\n
Required Skills<\/p>\n
Excellent knowledge of marketing and customer service,
\nGood oral and written communication skills,
\nMust be computer literate with MS Office applications skills,
\nAttention to detail, and
\nExcellent analytical skills.<\/p>\n
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