Back Office Supervisor 254 views

An emerging elite organization in the Healthcare Service Industry is seeking to recruit highly qualified individuals to join our team. Applications are invited from suitably qualified and experienced candidates for the following positions:

Duties And Responsibilities

Key Responsibilities:-

• Checks membership validity, limits & availability of benefits and authorizes;

• Sends notification of preauthorization decisions to the service providers;

• Attends to queries from members on membership and subscriptions;

• Assesses the needs of the members through highlighting gaps and areas of improvement in the business value chain;

• Applies knowledge of member servicing standards when dealing with members;

• Receives manual claims for processing;

• Identifies potential non-disclosure or misrepresentation and proceeds

to investigate the case or flag as fraudulent activity for escalation;

• Prepares claims for payment by analysing claims for reasonability, regulatory requirements, costs, etc;

• Interpretation of the Zimbabwe Relative Value Schedule (ZRVS) in line and in sync with the organisation’s procedure manual and limits;

• Interpretation of the Dental Manual & Ancillary Manuals in Claims adjudication;

• Repudiates claims that do not meet business and/or regulatory requirements within authority limits;

• Analyses and monitors staff competency and skill levels in specific work areas;

• Performs any other relevant duties as maybe assigned.

Person Specifications:-

• At least 50 Levels including English and Mathematics;

• Diploma in General Nursing;

• A Business degree qualification is an added advantage;

• At least 3 years post qualification hands on hospital experience;

• Claims assessing experience in health insurance industry is also an added advantage;

• Excellent computer skills; oriented attitude and ability to operate independently.