Back Office Supervisor

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Back Office Supervisor

  • Post Date:May 24, 2021
  • Views 395
0 Applications
  • Career Level Other
    Qualification Diploma
    Experience 3-5 Years
  • Industry Health Care
Job Description

An emerging elite organisation in the Healthcare Service Industry is seeking to recruit highly qualified individuals to join our team. Applications are invited from suitably qualified and experienced candidates for the position of Back Office Supervisor.

 

Key Responsibilities:-

  • Checks membership validity, limits & availability of benefits and authorizes;
  • Sends notification of preauthorization decisions to the service providers;
  • Attends to queries from members on membership and subscriptions;
  • Assesses the needs of the members through highlighting gaps and areas of improvement in the business value chain;
  • Applies knowledge of member servicing standards when dealing with members;
  • Receives manual claims for processing:
  • Identifies potential non-disclosure or misrepresentation and proceeds to investigate the case or flag as fraudulent activity for escalation;
  • Prepares claims for payment by analysing claims for reasonability, regulatory requirements, costs, etc;
  • Interpretation of the Zimbabwe Relative Value Schedule (ZRVS) in line and in syne withthe organisation’s procedure manual and limits;
  • Interpretation of the Dental Manual & Ancillary Manuals in Claims adjudication;
  • Repudiates claims that do not meet business and/or regulatory requirements within authority limits;
  • Analyses and monitors staff competency and skill levels in specific work areas;
  • Performs any other relevant duties as may be assigned.

Person Specifications:-

  • At least 50 Levels including English and Mathematics;
  • Diploma in General Nursing;
  • A Business degree qualification is an added advantage;
  • At least 3 years post qualification hands on hospital experience;
  • Claims assessing experience in health insurance industry is also an added advantage
  • Excellent computer skills;
  • A quality oriented attitude and ability to operate independently.

Interested candidates should submit applications, accompanied by a detailed Curriculum Vitae and certified copies of academic and professional qualifications by Thursday 27 May 2021. All applications should be emailed to [email protected] clearly indicating the position you are applying for as your E-mail Subject Reference:

N.B: Only shortlisted applicants will be responded to.