Job Summary
Applications are invited from suitably qualified and experienced persons for this job opportunity that has arisen in Cellmed Health Medical Fund.
Duties And Responsibilities
Reporting to the Risk Manager,
The main responsibilities of the job are:
• Review claims to identify errors, fraud, and trends.
• Pre-authorize hospital admitted patients and monitor member benefits.
• Register and follow up patients with chronic diseases under the chronic disease management program.
• Conduct workplace – based wellness programs for corporate clients.
• Investigate service providers and members with suspicious claiming patterns.
Qualifications And Experience
• Diploma in nursing
• Diploma/Degree in Insurance and Risk Management OR equivalent is an added advantage
• Diploma in Theatre nursing and/or midwifery is an added advantage
Ideal Candidate must:
• Have 2 years’ experience in claims investigations, case management and implementation of wellness programmes in a medical aid environment.
• Possess excellent investigative, problem solving and decision making skills.
• Have a strong client focus
• Have good written and verbal communication skills.
• Be a person of integrity who is transparent and able to observe and protect the confidential nature of information;