Claims Vetter at Apollo Life Assurance - APA Insurance

The person will be responsible primarily for vetting medical claims for processing into the Health system, identify conditions, procedures and rejection that will facilitate fast processing of claims. Identify claims that do not meet the criteria of APA policy, procedures and medical norms. Responsible for ensuring quality and accuracy of claims processed while maintaining the TAT and production levels necessary for provider and Client satisfaction.

KEY PRIMARY RESPONSIBILITIES

• Coordination and adjudication of all claims received
• 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
• 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
• Answering client inquiries on claims through e-mail, phone, or directly
• Reconciliation of provider accounts
• Filing of Claims processed as required

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
• Skill in Computer use and reporting
• Willingness to train and share knowledge with others
• Willingness to work on weekends when required

PROFESSIONAL QUALIFICATIONS

• Relevant professional qualification

EXPERIENCE

• At least 1 year’s experience in Health claim processing in a busy environment and/or at least 1 year’s experience  in a medical field