The key functions of the role will include but not limited to.

• • To timely register new claim submissions from accredited health care providers.
  • Track claims through the various subsequent workflows.
  • Timely update various claims registers and departmental trackers
  • Perform claims reconciliations both between internal workflow stations as well as with the various health care providers.
  • Attend to audit & claim queries from healthcare providers.
  • Admit all qualifying claims in the claims register immediately on receipt.
  • Maintain good business relationship with  Health Care Providers and conduct Health Care Provider sensitisation on NHIMA Benefits, Tariffs, and importance of properly filled in claim forms.
  • Communicate daily to healthcare providers with claims submission omissions.
  • To be able to scan, batch and index claims prior to adjudication.
  • To prepare daily, weekly, claims status reports.
  • To manage the weekly claims adjudication schedule and submission.
  • Participate in any other claims process roles as demand arises and as guided by the Supervisor.
  • Conduct any other roles as assigned by the Supervisor.

• Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language (ZAQA Certified).
• Diploma in a relevant field (ZAQA Certified).
• Degree in relevant field will be an added advantage (ZAQA Certified).
• More than six (6) Months relevant work experience in a similar role,
• Certificate in management of a health insurance scheme, compensation fund or social security will be an advantage

• Excellent knowledge of marketing and customer service,
• Good oral and written communication skills,
• Must be computer literate with MS Office applications skills,
• Attention to detail, and
• Excellent analytical skills.