PURPOSE:

Responsible for receiving and processing claims for provider payment.

PRIMARY RESPONSIBILITIES:

• Ensure that all claims received are well stamped and keyed in for future reference
• Dispatch received invoices, mails and claim books to respective sections
• Dispatch claim forms and other relevant documents to providers
• Confirm that smart claims have been billed correctly
• Prepare valid claims for scanning
• Upload, attach and index relevant documents to Document Management System
• Facilitate discarding of scanned claim documents as per the approved disposal procedure
• Registration of medical claims in the system
• Follow up on registration and reconciliation of provider statements to ensure closure.
• Follow through to ensure all claims with issues at registration level have been addressed or escalated to the supervisor for action
• Respond to walk in customer enquiries
• Attend to customer and service providers’ queries and complaints promptly and professionally

Academic Qualifications

• Bachelor’s degree in Commerce or in a related field

Experience

• Up to one (1) year relevant experience

Skills and Attributes

• Good analytical skills
• Excellent communication and presentation skills
• Problem solving skills
• Excellent interpersonal skills
• Computer literate in MS Office and other office applications

PURPOSE:

Responsible for offering legal counsel, negotiations to ensure settlement of third party claims and recovery on behalf of the company.

PRIMARY RESPONSIBILITIES:

• Reviewing judgments and recommending settlement or appeals. Making sure that adequate reserves are maintained
• Reviewing legal claims lodged against our insured’s and engaging third parties in out of court negotiations in line with past precedents and set parameters. Always ensuring that adequate reserves are maintained
• Receiving summons to enter appearance and plaint from our insured’s and distributing the same to our panel of external advocates
• Distributing the work coming into the claims legal department ensuring that all mails are handled
• Approving all discharge vouchers and judgments as per the approval limits
• Co-ordinate the out of court committee sittings and provide periodic report on the performance
• Reviewing the charges charged by our external advocates to ensure that the fee notes are raised as per remuneration order
• Providing legal advice, opinion and assistance on all legal claims matters to the management
• Attending court hearing on behalf of the organization as and when required

Academic Qualifications

• Degree in Law or in a related field

Professional Qualifications

• Postgraduate Diploma in Law (Admission to the bar and holder of a current practicing certificate is a requirement
• Diploma in Insurance (Added advantage)

Experience

• Minimum of six (6) years’ relevant experience, two (2) of which are at supervisory level

Skills and Attributes

• Good analytical skills
• Decision making skills
• Excellent communication and presentation skills
• Problem solving skills
• Basic Knowledge of regulations by AKI and IRA
• Understanding of the working environment /competitors
• Excellent interpersonal skills
• Computer literate in MS Office and other office applications