Senior Claims Analyst UIC Medical job at Old Mutual

JOB DETAILS:
Job Description
• To process, initiate service provider payments and communicate payments statements to service providers
• Timely verification and vetting of all medical provider invoices.
• Timely communication of payments to service providers and sharing statements.
• Manage benefit utilization and report on the same
• Recommend cover design to underwriter as a result of vetting
• Verify and review all medical claims invoices and provide recommendations on cover design aspects as a result of verification to Underwriting
• Processes documentation all medical claims for settlement and ensures claim files are signed promptly
• Negotiates professional and procedure fees with service provider and ensure fess are within Medical Board rates
• Manages administration of outpatient self-funded schemes for specifically allocated schemes as well as benefit utilization management of the same ensuring reports are generated on a quarterly and annual basis to Claims Supervisor and scheme managers
• Gives feedback to underwriting on claims which require future intervention including prompt reporting on fraud cases, overpricing issues and over utilization and liaising with scheme manages and service providers
• Follows up recoveries from employers and insured for settlement paid on behalf
• Any other duties assigned by employer

Skills
• Authentication, Communication,
• Computer Literacy,
• Customer Service,
• Documentations, Invoices,
• Medical Claims, Payments,
• People Management,
• Taking Initiative,
• Teamwork,
• Utilization Management,
• Vetting

Education
• Bachelors Degree (B): Medical Claims Assessing (Required), Bachelors Degree (B): Nursing (Required)

Job application procedure
Interested and Qualified? Click here to apply

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