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Junior Claims Assesor Job Stratostaff
Medical Jobs. Stratostaff Jobs
Job Description
Claim Assessment Duties/Case Management Duties
Support our client’s Existing and Potential Customers by:
- Verify and analyze all data on claims/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/cases 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 and cases 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 Our Client.
- 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/case assessment exercise.
- Mapping generic rules to medical services, procedures, drugs and lab tests
- Participate in testing and documentation of selected client systems.
- To perform all other duties as assigned by the supervisor.
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Requirements
- 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).
SKILLS AND COMPETENCIES:
- Good analytical and problem-solving skills
- Excellent oral and written communication skills
- Strong interpersonal skills with ability to work with cross-cultural and diverse people and teams.
- Collaboration and team working skills.
- Customer service skills
- Data Entry skills with ability to produce accurate work.
- Reporting and good attention to details
- Ability to prioritize and work to meet deadlines.
- Flexible and ability to adapt or change to new situations and handle high levels of uncertainty.
- Ability to maintain confidentiality.
- Personal qualities of integrity, credibility, professionalism, and a commitment to our client’s mission
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How to Apply
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