Claims Loader/ Vetter at Apollo Life Assurance - APA Insurance

The person is expected to identify claims that do not meet the criteria of APA policy, procedures, and medical norms to ensure the quality and accuracy of claims processed while maintaining the TAT and production levels necessary for provider and client satisfaction. He/ she will also be responsible for vetting medical claims for processing into the Health system, identifying conditions, procedures, and rejection that will facilitate fast processing of claims.

KEY PRIMARY RESPONSIBILITIES

• Coordination and adjudication of all claims received
• Monitoring, preventing, and highlighting medical claims fraud through regular claim audits and reporting
• Follow up with providers for bills, discrepancies in bills, and other information that is holding up processing
• Vetting of claims in line with APA policy, procedures, and benefits to ensure accuracy of processing and TAT.
• Processing of claims, as required, to ensure that production levels  and TAT are met
• Negotiation where necessary of professional fees and charges, including discounts, to control costs
• Reconciliation of provider accounts
• Answering client inquiries on claims through e-mail, phone or directly

ACADEMIC QUALIFICATIONS

• Degree holder and/or Diploma in Insurance, Health management, Nursing, or other health-related fields

JOB SKILLS AND REQUIREMENTS

• Integrity and honesty
• Able to manage tight deadlines
• Attention to detail and to following processes
• Excellent written and spoken communication skills
• Proficient in Microsoft Office
• Willingness to train and share knowledge with others
• Willingness to work weekends when required

PROFESSIONAL QUALIFICATIONS

• Diploma/Certificate in insurance is an added advantage

EXPERIENCE

• At least 1 years’ experience in Health claim processing in a busy environment