CLAIMS ASSESSOR 306 views

Key Responsibilities

• Prepares and analyses claims for payment, reasonability, regulatory requirements, costs etc;
• Interprets the Zimbabwe Relative Value schedule in sync with organisation’s procedure manuals;
• Repudiates claims that do not meet regulatory requirements within normal limits;
• Applies working knowledge of AHFOZ tariffs, benefits/ rules and limits when processing claims;
• Identifies potential non-disclosure or misrepresentation and proceeds to investigate the cases.

Person Specification:

• At least 5 O Levels including English and Mathematics;
• Diploma in General Nursing;
• At least 3 years post qualification hands on hospital experience;
• Claims assessing experience in health insurance industry is an added advantage;
• Excellent computer skills.