CLAIMS ASSESSOR

Job Description

Applications are invited from suitably qualified and experienced persons to fill the above vacancy that has arisen within First Mutual Health Proprietary Limited – Botswana.

Key Responsibilities

• Contributing to the continuous improvement of processes within the Claims department.
• Adjudicating claims for accuracy and appropriateness before payment.
• Processing preauthorisations at the request of members and service providers.
• Engaging health service providers where clarifications on claims or quotations are required, or around claiming procedures.
• Attending to email, telephone and in-person queries on claims and preauthorizations from members and service providers.
• Investigating the nature of queries and resolving or contributing to the resolution of the queries.
• Devising and implementing strategies to identify any fraud, waste and abuse on submitted claims before payment.
• Attending to ad hoc requests by service providers and members in a timely manner.

Qualifications & Experience

• A diploma or degree in Nursing Science or a similar healthcare qualification is required.
• A qualification in healthcare forensics is an added advantage.
• Two years’ experience in a similar environment
• Excellent organizational skills
• Detail-oriented personality
• Strong communication skills

How to Apply

To apply, please visit: https://forms.cloud.microsoft.com/r/6Y0LN7fPKv Please state that you got the job advert through JobHub BW website when submitting your application.