Job Title: Senior Claims Analyst UIC Medical
Organisation: UAP Old Mutual Insurance
Duty Station: Kampala, Uganda
About US:
The UAP Old Mutual Group is an integrated Financial Service business comprising Faulu Microfinance Bank, UAP and Old Mutual. The Group, which is operational in East Africa services to more than 1.2 million customers across Kenya, Uganda, Tanzania, Rwanda and South Sudan. The UAP Old Mutual Group now comprises of three key players as a result of the acquisition of a controlling stake in Faulu in 2014 and UAP in 2015 by Old Mutual. The acquisitions resulted in Old Mutual Kenya UAP Holdings and Faulu Microfinance Bank, forming one of the largest financial services groups with a growing footprint in East and Central Africa. UAP and Old Mutual have been major players in the financial services market in East Africa for decades. The two entities have vast experience in Insurance, Investment, Asset Management and Banking, and are passionate about helping our customers achieve their financial goals.
Key Duties and Responsibilities:
- To process, initiate service provider payments and communicate payments statements to service providers
- Timely verification and vetting of all medical provider invoices.
- Timely communication of payments to service providers and sharing statements.
- Manage benefit utilization and report on the same
- Recommend cover design to underwriter as a result of vetting
- Verify and review all medical claims invoices and provide recommendations on cover design aspects as a result of verification to Underwriting
- Processes documentation all medical claims for settlement and ensures claim files are signed promptly
- Negotiates professional and procedure fees with service provider and ensure fess are within Medical Board rates
- Manages administration of outpatient self-funded schemes for specifically allocated schemes as well as benefit utilization management of the same ensuring reports are generated on a quarterly and annual basis to Claims Supervisor and scheme managers
- Gives feedback to underwriting on claims which require future intervention including prompt reporting on fraud cases, overpricing issues and over utilization and liaising with scheme manages and service providers
- Follows up recoveries from employers and insured for settlement paid on behalf
- Any other duties assigned by employer
Qualifications, Skills and Experience:
- The applicant must hold a Bachelor’s Degree (B): Medical Claims Assessing (Required), Bachelors Degree (B): Nursing (Required)
- Skills: Authentication, Communication, Computer Literacy, Customer Service, Documentations, Invoices, Medical Claims, Payments, People Management, Taking Initiative, Teamwork, Utilization Management, Vetting
How to Apply:
All candidates should apply online at the link below.
Deadline: 10th November 2023