Responsibilities:
    * Oversight of the claims process flows to ensure efficiency in processing of claims as per the company medical claims procedure manuals
    * Verification and audit of outpatient and inpatient claims as per the claims manual and customer service charter manual to ensure compliance and mitigate risk.
    * Negotiate professional fees and hospital charges including discounts to control expenditure.
    * Oversee processing, settlement of all claims and authorize requisitions.
    * Holding regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs.
    * Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers.
    * Supervise, train and mentor medical claims staff to achieve a high level of motivation and productivity by the team.
    * Prepare regular claims reports to clients, management and advice underwriter health on relevant claims findings for medical risk review.

Qualifications:
    * Diploma or Degree in Nursing
    * Diploma in Insurance and or a degree in Health systems Management/ Business management will be an added advantage

Key Competencies:
    * 2 years experience in clinical setting
    * At least 3 years of experience working as a claims team leader in a busy insurance environment
    * Excellent communication and negotiation skills.
    * Excellent public relations and interpersonal relationship skills.
    * Extensive networking with SP and other medical insurers
    * Excellent analytical and monitoring skills
    * User IT skills in database management and office systems.
    * Ability to evaluate decisions made in benefit utilization management.
    * Integrity and honesty