Job Description
To manage specific cases in the branch in order to get the best outcome
To facilitate the process of pre-authorisations and authorisations between the provider and the scheme and to give feedback to the relevant party concerned
To facilitate resolution of all queries from providers and members within the branch on specific cases and within the agreed SLA
To facilitate the investigation of potential fraudulent claims within the specific branch and provide feedback to the Branch manager
Hospital visits regarding specific branch cases
To provide services in the accreditation and re-accreditation of branch providers to ensure that provider facilities and services are up to standard as per the agreed standards using a standardized checklist
To adhere to and live the organizational values
Following Head Office approval, to ensure a successful provider forum is held as stipulated
To ensure provider education is done and ensure product knowledge and processes are understood towards seamless service delivery to enrollees
Requirements
Candidate must be a registered nurse
B.Sc. Nursing and additional medical qualification will be an added advantage
Candidate must have minimum of 3 years medical experience including 2 years in similar role in an Health Maintenance Organization (HMO)
Candidate must have advanced knowledge of NHIS regulatory guidelines, Medical Global Best Practices, Health Insurance, Products and Processes, and Scheme Rules.
Excellent organizational, communication (verbal and written), listening skills and attention to detail.
Candidate must be very proficient in Microsoft office packages
Other Requirements:
Good organizational and planning capabilities
Innovative and quick thinking capabilities
Adaptive
Decision Making skill and Excellent Customer Service Skill
Integrity
Ability to work under pressure
Adaptive, expertise, Result-Oriented, Relationship Skill
Working with people
Interpersonal Skill
Must be a good collaborator/Team player
Apply via :
totalhealthtrustlimited.has-jobs.com
