Junior Claims Assesor at Stratostaff

Job Description

Claim Assessment Duties/Case Management Duties

Support our client's Existing and Potential Customers by:

• Verify and analyze all data on claims/cases and ensure these meet the project objectives as well as payer expectations for the various projects.
• To send back simple yet detailed feedback to the provider team where claims/cases do not meet the project expectations.
• To ensure any general trends or inconsistencies noted are reported to the operations and provider teams.
• Timely assessment of claims and cases submitted by the providers, ensuring the queries raised are understood, and following up with the provider team to ensure they are resolved.
• Provide support to the customer call center to address medical queries that have been escalated to Our Client.
• Document and be able to extract, present, or discuss provider practices or disease trends.
• Deliver feedback and training aimed at addressing the trends picked from the claims/case assessment exercise.
• Mapping generic rules to medical services, procedures, drugs and lab tests
• Participate in testing and documentation of selected client systems.
• To perform all other duties as assigned by the supervisor.

Requirements

• Degree / Diploma in Clinical medicine or Nursing.
• Good understanding of private and public healthcare delivery.
• Have a strong understanding of medical treatment protocols and cost-effective prescribing habits in relation to market segmentation.
• At least 2 years’ experience in a busy hospital set-up. (Experience in insurance will be an added advantage).

SKILLS AND COMPETENCIES:

• Good analytical and problem-solving skills
• Excellent oral and written communication skills
• Strong interpersonal skills with ability to work with cross-cultural and diverse people and teams.
• Collaboration and team working skills.
• Customer service skills
• Data Entry skills with ability to produce accurate work.
• Reporting and good attention to details
• Ability to prioritize and work to meet deadlines.
• Flexible and ability to adapt or change to new situations and handle high levels of uncertainty.
• Ability to maintain confidentiality.
• Personal qualities of integrity, credibility, professionalism, and a commitment to our client's mission.