Life Quest Technologies Limited is an InsureTech company.

Our services are technology-based enterprise applications mainly for the Health & Life Insurance companies, corporate, government and non-profit donors who use this as license or on Cloud/SAAS basis and includes modules such as reporting, analysis, reinsurance, policy, underwriting, policy administration, claims, mobile apps etc.

Our esteemed clients use our software systems around the globe to manage sustainable & profitable operations and policy servicing, its technical aspect of insurance product underwriting and claims management. Our expertise is building capacity to insurers core businesses and growth by helping local insurance companies become profitable and more sustainable.

We identify and bridge the gap between stakeholders (Health Insurance & Healthcare industry, users policy holders) and assist the industry for the financial and economic development and related outsourcing of business processes service of Insurance companies (Local and International).

This comes with a great reputation for flexibility & innovation, outstanding customer service, and tailored solutions for the Healthcare service providers to fast track their claims payments, real time paperless operations, and other unique advantages.

2 POSITIONS- HCP RELATIONSHIP OFFICER- ASSISTANT

LOCATION- LUSAKA
REPORTING TO THE MANAGER –CUSTOMER SERVICE CLAIMS & CASE MANAGEMENT

PURPOSE- PROVIDERS ACCOUNT & CLAIM RECONCILIATIONS & RELATIONSHIP MANAGEMENT

Essential Duties-

• Plan Hospital Risk and case management visit to familiarize Case Managers with the patient’s condition to be able to do the relevant interventions
• Carry and manage Company emergence line 24X 7. Ensure that Life Quest Tech receives the pre-auth from hospitals
• Accounts reconciliation of claims settlement of all eligible medical claims within agreed service level agreements (SLA) with the network health care providers and Insurers
• To ensure that Health Care Providers are informed in time of the incomplete and hold claims to avoid unnecessary disputes and disruptions in services due to non-payment of claims
• Responsible for managing relationships and monthly billing reconciliations between the accounts dept and various Insurance Companies/ Healthcare Providers to ensure that claim are settled within SLA; send claim settlement advice to the health care providers within 48 hours of receiving confirmation of transfer and sign off on monthly billing basis
• Reconcile of all payments with health care providers within 60 days of receiving settlement transfer advice; health care providers are required to re-submit suspended claims requiring additional/missing information within 30 days of advice and you will be required to ensure that this is adhered to as per SLA

General Duties-

• Ensure that the providers adhere to the Insurer policy cover during the member’s hospitalizations
• Liaise with the network providers to ensure a seamless admission and discharge process of members
• Ensure the member bill are collected from their respective hospital
• Vet all bills as per policy biding the medical scheme at hand
• Be able to submit reports as per SLA of respective clients
• Continuous training and maintaining good relationships with HCP partners
• Maintain patient data & Confidencialty as per Life Quest Tech policy

KEY QUALIFICATIONS:

• Diploma in Nursing or any medical related field
• Mandatory Min 2 years working in any Healthcare with claims background
• High level of healthcare business awareness
• Understanding of the healthcare business strategies, objectives
• Good knowledge of the medical practices, accounting methods
• Mandatory Driver’s license

PERSONAL ATTRIBUTES:

• High standards of honesty and integrity
• Self-Starter & Highly Innovative
• Resilient and ability to work under pressure
• Passion for and attention to detail
• Pleasant and friendly personality
• Passion for customer/ People care
• Good communicator, both orally and written
• Team Player & Sense of Urgency
• Concern for order and quality
• Mandatory knowledge and understanding of computer and a quick learner insurance operating system

QUALITIES & SKILLS REQUIRED UNDERTAKING THE ROLE:

• Quantitative/Statistical skills
• Relationship Management Skills
• Good Interpersonal Skills
• Accounting Skills & Analytical & Planning Skills
• Time Management & Negotiation skills
• Planning and Organisation
• Tact and Diplomatic skills
• Computer & Technology savvy

REMUNERATION

No constraints for the right candidate or open for discussion