Quality Assurance Officer at APA Life Assurance Company Ltd

Job description

Responsible for ensuring claims processes and services meets the established standards to guarantee efficiency, monitor and prepare controls for managing claims cost

KEY PRIMARY RESPONSIBILITIES

• Conduct an audit of overall claims settled, placing special attention to high value, repeated visits, and duplicate claims. Check the error rate.
• Review of STP claims in line with acceptable process agreement
• Identify Providers with significant billing irregularities or suspected of fraud and have regular provider engagement issues on billing.
• Admissions tracking; checking on exaggerated bills, unnecessary admissions or overstay admissions, and doctors’ charges.
• Enforce claims cost controls e.g. co-payments, discounts, provider restrictions, waiting periods
• Frequent claimants, irregular services against MOH clinical standards of service
• High average cost providers
• Reimbursement reports review to pick exceptions and cold calling/impromptu visits.
• Monitor and share reports of TATs for all key claims processes credit, reimbursement claims, discount claims.
• Identify areas of improvement and scale up the STP process.

ACADEMIC QUALIFICATIONS

• Business Related Degree 
• Medical background
• Risk / Quality assurance experience will be an added advantage

JOB SKILLS AND REQUIREMENTS

• Team player with strong interpersonal and persuasive skills 
• Good Communication and interpersonal skills
• Good analytical skills and keenness to details
• Excellent Negotiation skills and Effective decision maker

PROFESSIONAL QUALIFICATIONS

• Certificate of Insurance Proficiency or any Insurance-related qualifications
• Quality Assurance professional qualification will be an added advantage

EXPERIENCE

• At least 3 years of relevant experience in a busy environment