Claims Assessor

Closing Date 2024/11/14

Reference Number MMH241018-6

Job Title Claims Assessor

Position Type Permanent

Role Family Client Services

Cluster International

Remote Opportunity None of the time

Location - Country Ghana

Location - Town / City Accra

Introduction

Metropolitan Health Insurance Ghana Ltd is a reputable company with the vision to be the preferred lifetime financial wellness partner, with a reputation for innovation and trustworthiness.

We are hiring urgently. Are you a proactive and result oriented professional looking for a new opportunity with a prestigious fast paced company? If your answer is “yes" this is the position for you.

Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose Assess, review and manage living benefit claims, in accordance with relevant legislation and company policy, adhering to service level agreements and meeting client and business expectations.

Requirements

• At least a first degree in related field from a recognized university.
• 2-3 years’ work experience in a similar environment will be an advantage
  
  

Duties & Responsibilities

• Ensure strict adherence to network tariffs for network providers assigned to you
• Adjudicate and Process 100 claims daily to ensure adherence to scheme rules, products, and benefit rules
• Reconcile all claims statements in the checklist for each run for payment within 24 hours of the claims run
• Ensure queries regarding rejected claims with the collaboration of the Provider relations team is explained to the understanding of providers within 24 hours of request by PR Team or Service Providers.
• Ensure a claims processing turnaround-time of 30 days for all providers allocated to you
• Ensure total compliance with all legal/regulatory requirements by paying claims with 30days as stipulated in our SLAs with service providers.
• Daily interaction with Provider Relations team for claims preauthorization approval, claims processed and reconciled runs to resolve provider queries to avoid service suspension by providing feedback within 24 hours of receiving complain from Provider relations
• Innovate on processes to ensure Claims processes are efficient and effective and standards are maintained and exceeded.
• Build and maintain relationships with clients and stakeholders
• Provide authoritative, expertise and advice to clients and stakeholders
• Perform any other task assigned by Supervisor within scope and content of job
  
  

Competencies

• Business Acumen
• Client/Stakeholder Commitment
• Collaboration
• Impact and Influence
• Self-Awareness and Insight
• Diversity and Inclusiveness
• Drive for Results