Job descriptions & requirements
ABOUT THE COMPANY
CarePay Limited is an independent company that administers healthcare payments between funders, patients and healthcare providers. It directs finances from both public and private funders to healthcare providers for delivery of quality services to their eligible target group.
JOB SUMMARY
RequirementsDegree/ Diploma in Clinical Medicine or NursingGood understanding of private and public healthcare delivery.Have a strong understanding of medical treatment protocols and cost-effective prescribing habits in relation to market segmentation.At least 2 years’ experience in a busy hospital set-upExperience in insurance will be an added advantage.
RESPONSIBILITIES
Verify and analyze all data on claims or cases and ensure these meet the project objectives as well as payer expectations for the various projects.To send back simple yet detailed feedback to the provider team where claims do not meet the project expectations.To ensure any general trends or inconsistencies noted are reported to the operations and provider teams.Timely assessment of claims re-submitted by the providers, ensuring the queries raised are understood, and following up with the provider team to ensure they are resolved.Provide support to the customer call center to address medical queries that have been escalated to CarePay.Document and be able to extract, present, or discuss provider practices or disease trends.Deliver feedback and training aimed at addressing the trends picked from the claims assessment exercise.Mapping generic rules to medical services, procedures, drugs and lab tests.Participate in testing and documentation of selected CarePay systems.Perform all other duties as assigned by the supervisor.
REQUIRED SKILLS
Handling claims, Written communication, Reporting, Risk analysis, Customer service, Compliance
REQUIRED EDUCATION
Bachelor's degree
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