Vacancy title:
Head of Claims & Medical Advisor

Jobs at:
IAA Health Care

Deadline of this Job:
30th April 2018.

Duty Station:
Kampala, Uganda

JOB DETAILS:
About US:
IAA Healthcare, the leading Health Management Organization in Uganda, is part of the international Medical Group (IMG) that integrates international Hospital Kampala (IHK), international Medical Centre (IMC) and international Medical Foundation (IMF).

Our brand:
IAA Healthcare has been providing medical insurance products and professional services to customers since 2001.

To cope with our business growth, we are now looking for a qualified candidate to join our dynamic team as Head of Claims and Medical Advisor.

Job Title: Head of claims &medical advisor
Organization: IAA healthcare
Duty Station: Kampala Uganda
Reports to: General Manager

Job Summary:
The Head of Claims and Medical Advisor will supervise the claims team to achieve set business objectives and oversee the medical claims processes and procedures through use of effective techniques to achieve the objectives of claims cost control, operational efficiency while meeting customer service needs for clients. The Head of Claims will also ensure consistent management of provider relationships through selective contracting and timely payments.

Key Duties and Responsibilities:

• Management of the claims process to ensure efficiency in processing of claims as per the company medical claims processes
  
• In charge of the verification and audit of outpatient and inpatient claims as per the claims processes to ensure compliance and mitigate risk.
  
• Negotiate professional fees and hospital charges including discounts to control expenditure.
  
• The incumbent will manage the processing and settlement of all claims, and authorize requisitions and reimbursements.
  
• Holding regular business meetings with service providers to ensure compliance on contract terms, use of agreed billing systems and agreed tariffs.
  
• Actively monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/processes as well as providers.
  
• Supervise; train and mentor medical claims staff to achieve a high level of motivation and productivity by the team.
  
• Ensure good case management for clients
  
• Monitoring and improving claims processing turnaround time, practices and procedures
  
• Handle clients and service provider complaints
  
• Conduct claims control and analysis
  
• Participate in service meetings within the group and attend staff benefit briefing sessions as required
  
• Prepare regular claims reports to clients, management and advice underwriter health on relevant claims findings for medical risk review

Qualifications, Skills and Experience:

• Medical Training
  
• A Medical Degree with relevant clinical experience plus experience in management.
  
• 3 years minimum experience in medical claims management and underwriting.
  
• Possession of a Diploma in insurance and or a degree in Health systems Management! Business management will be an added advantage
  
• Excellent communication and negotiation skills
  
• Possess excellent public relations and interpersonal relationship skills
  
• Extensive networking with health service providers and other medical insurers
  
• Excellent analytical and monitoring skills
  
• User IT skills in database management and office systems
  
• Ability to evaluate decisions made in benefit utilization management
  
• High degree of integrity and honesty

Job application procedure
Should you meet the above requirements, kindly email your application letter, CV, copies of certificates including daytime telephone numbers to the Head of Human Resources at iaa@img.co.ug by 30th April 2018.

Also note that only successful candidates will be contacted and any canvassing will lead to automatic disqualifications