Job Opportunities at Resolution Insurance

Key Responsibility Areas Of The Relations Executive

• Set up new MSPs, establish and maintain proper coding and data as per supplier requirements
• Maintain effective and ongoing communication with internal and external clients on provider issues, queries and complaints
• Maintain various claims processing and procedure records necessary for the department
• Ensure timely follow up and resolution of claims disputes
• Follow up on credit notes and claims and counter-check each against transaction lists and/or claims records
• Produce all relevant departmental reports and reconciliations on disputed claims with clear reasons for each action taken.

Qualifications Required for the Relations Executive Job

Essential

• Diploma in business related field
• CPA I certification
• 6 months – 1 year relevant working experience
• Accounting Knowledge an added advantage

Desirable

• Experience in the Insurance Industry
• Good public relations and customer service skill

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Key Responsibility Areas of the Claims Adjudicator:

• Analyze claims in details for processing.
• Accurately vet and code valid claims for payment.
• Resolve and reconcile problems related to claims, by liaising with the providers and other relevant
  stakeholders.
• Identify and prevent fraud instances in the claims process.
• Achieve daily targets as stipulated in the claims policy.
• Maintain the claims timelines as stipulated in the claims policy.
• Timely processing of the claims within the approved matrix levels.
• Timely clearance of all claims batches as stipulated in the claims policy.
• Escalation of non-resolved issues to MSP relations within 7 days of initial contact with MSP.
• Prepare the relevant departmental reports.
• Communicate with clients or MSPs regarding claims.

Qualifications Required For The Claims Adjudicator Job:

Essential

• Diploma in a clinical medicine or Nursing.
• KRCHN or KRN/M Certification.
• At least 3 years relevant experience in health management.

Desirable

• In-depth knowledge of health management
• Computer skills including knowledge of Microsoft Office.

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Job Purpose
Reporting to the Head of Internal Audit, The job holder’s role will be primarily responsible for the execution of risk based internal audits in accordance with the annual audit plan as well as carrying out special audits / investigations.

Key Responsibility Areas:

• Appraise the soundness, adequacy and application of the internal control systems in assigned areas;
• Report risk management and internal control deficiencies identified to the Internal Audit Manager;
• Keep abreast with compliance procedures and other applicable laws and regulations;
• Undertake and complete internal audit plans within given timelines as directed by the Internal Audit Manager;
• Maintain working papers in support of audits conducted;
• Managing a variety of stakeholders and their expectations through regular communications. Required Qualifications, Knowledge, Skill and Ability

Knowledge & Experience Required
Essential

• Business related degree (Accounting/Finance etc.)
• CPA (K) or ACCA (those sitting for their final stages are acceptable.)
• Minimum 3 years relevant audit experience.
• Auditing experience in financial services industry (with a bias to Insurance Industry) will be an added advantage.
• Desirable
• Understanding of insurance business, design and implementation of internal controls and the audit cycle.
• Strong analytical thinking and keenness to details
• Excellent communication (written reports) and interpersonal skills
• Working knowledge of MS Spreadsheets and Computer Aided Audit Tools (CAATs).