Job Title: Customer Care and Claims Coordinator
IAA-Resolution, which is a partnership between IAA Healthcare and Resolution Health East Africa, offers healthcare packages that provide our clients with high value in benefits and unique service. IAA- Resolution has a strong accredited medical service provider network of over 500 hospitals, clinics and doctors all across East Africa. We also provide access to over 750 health hospitals and clinics in East Africa and South Sudan to the over 106,000 members who entrust us with their healthcare security.
Job Summary: The Customer Care and Claims Coordinator will serve as the liaison to ensure that all relevant communication and authorisations for medical services to the members are seamlessly executed to ensure member satisfaction and client retention. The incumbent will also ensure that all claims received within the department adhere to the company’s regulations and are accurately processed into the system for payment. The jobholder will be expected to demonstrate leadership and professionalism and perform all duties in accordance with the organization’s policies and procedures, keeping in mind the overall business objectives.
Key Duties and Responsibilities:
1. Care Management:
- Cordially answer clients (internal and external) and providers queries on policy benefits details including but not limited to balances, providers they can access and coverage details in a timely manner
- Coordinate outpatient undertakings for clients without membership cards or those missing on the active list in hospitals.
- Coordinate referrals for clients and track delivery of the same.
- Coordinate member post-discharge follow up calls to check on their progress, any additional service requirements and provide any additional support.
- Log help desk interactions and forward to relevant persons to assist depending on the query type.
- Generating outpatient reports which include dental, optical, referral and outpatient quarterly reports to compare on the quarter budgets and presenting to the department.
- Plan, prepare and budget for care packages and prepare relevant documentation for the same
- Ensure prompt filing and efficient retrieval of reports and any relevant documentation.
2. Claims Receiving:
- Sort, stamp and verify received claims and invoices into outpatient, inpatient, refunds and resubmissions.
- Manage the front office, make/place calls and assist walk-in clients
- Maintain a record of claims delivered.
3. Documents Management:
- Scan all received claims and documentation.
- Index the captured claims in the DME application.
4. Claims Capture:
- Accurate and timely capture of Claims in the company’s Management Information System.
- Ensure timely submission of claims to the adjudicator for final vetting before dispatch.
- Prepare claims reports for analysis and decision making.
- Perform any other duties assigned by the Manager.
Qualifications, Skills and Experience:
- The candidate should possess a diploma in a relevant field.
- At least 6 months – 1 year relevant work experience.
- Excellent customer service and PR skills
- Excellent communication and interpersonal skills
- Good negotiation and problem solving skills
- Possess the ability to work responsibly with or without direct supervision.
How to Apply for the job:
All candidates should send their electronic application to: email@example.com consisting of your application letter and updated CV listing three references, quoting the position in the email subject.
Deadline: 8th August 2014 by 5PM