Jobs at CarePay Ltd

The Junior Claims Assessor will have the responsibility of ensuring that medical claims and cases are vetted and that they meet the set objectives for a given project. The position will also involve giving detailed reporting on all the general findings from the claims or cases vetted with the aim of improving project outcomes as well as enhancing system functionality.

KEY DUTIES AND RESPONSIBILITIES:

• Verify and analyze all data on claims or 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 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 re-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 CarePay.
• 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 assessment exercise.
• Mapping generic rules to medical services, procedures, drugs and lab tests.
• Participate in testing and documentation of selected CarePay systems.
• Perform all other duties as assigned by the supervisor.

EDUCATIONAL QUALIFICATIONS, KNOWLEDGE & EXPERIENCE:

• 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.

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As a Manager in the PPM team, you will play the leading role in translating data into insights that drive key decisions around how clients get access to healthcare. This will entail structuring the problems to be addressed, coming up with analyses, building dashboards and other tools, conducting deep dives, generating recommendations, presenting these to internal and external stakeholders and evaluating the impact of your recommendations. This role is ideal for a highly quantitative, analytical and commercially minded professional who is not afraid to “roll up their sleeves”. The role may start as an individual contributor (IC) role and will then transition to managing one or more analysts over time.

The PPM team is an impact-driven team that values curiosity, ownership, and a collaborative approach to solving complex problems. We believe great work happens when people enjoy what they do and who they do it with. If you have an interest in the intersection of analytics and healthcare, then this role is for you.

KEY RESPONSIBILITIES:

• Design and implement analyses to identify trends, opportunities, and potential risks.
• Build and maintain dashboards and data visualizations for real-time performance tracking.
• Provide actionable insights and recommendations to the team and other internal/external stakeholders.
• Proactively support colleagues in provider engagements as needed.
• Build, own and manage various client relationships as necessary.
• Ensure accuracy and consistency of own/team reports.
• Build and continuously improve our internal processes to ensure compliance, consistency across client portfolios and scalability.
• Coach, manage and mentor one or more analysts as needed.
• Set clear goals, delegate tasks and manage performance of direct reports.
• Represent the team in various internal and external forums.
• Provide any other relevant support as needed.

YOUR AREAS OF EXPERTISE:

• Bachelor’s degree in a quantitative discipline (e.g., Statistics, Finance, Accounting, Mathematics, Engineering or other hard sciences etc.)
• Master’s degree in a quantitative field or MBA is ideal but not mandatory.
• 7+ years of experience in a fast-paced, analytical environment preferably in strategy or management consulting, an established start-up/scale-up, or a health insurer
• Advanced in data analysis, financial modelling, and building data visualizations
• Proficient in Microsoft Excel; SQL knowledge preferred.
• Excellent written and verbal communication skills, with the ability to translate complex analyses into clear, actionable recommendations