Description
CLAIMS ASSESSORS

A leading organisation in the Healthcare Service Industry is seeking to recruit highly qualified individuals to join our dynamic team. Applications are invited from suitably qualified and experienced candidates for the above-mentioned position.

Duties and Responsibilities
KEY RESPONSIBILITIES

Reporting to the Team Leader, the position shall be responsible for the following, among other duties:

* Prepares and analyses claims for payment, reasonability, regulatory requirements, costs, etc.
* Interprets the Zimbabwe Relative Value Schedule, in sync with organisation’s procedure manuals.
* Repudiates claims that do not meet regulatory requirements within normal limits.
* Applies working knowledge of AHFoZ tariffs, benefits/rules and limits when processing claims.
* Uses practical industry knowledge in line with organisational tariffs, benefits, rules and limits when processing claims.
* Identifies potential non-disclosure or misrepresentation and proceeds to investigate the cases. BuyMaps

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Qualifications and Experience
PERSON SPECIFICATIONS

* At least 5 O Levels.
* Diploma in General Nursing.
* At least 3 years post qualification hands-on clinical, hospital experience.
* Claims assessing experience in the health insurance industry is an added advantage.
* Excellent computer skills.