Summary
Date Posted: Thursday, June 08, 2023 , Base Salary: Not Disclosed

JOB DETAILS:
Role Purpose:
The Head of Medical Claims is responsible for the overall training and smooth operations of the Claims Department. This role plays a vital role in ensuring that department targets for Turnaround Time, Quality, and Productivity are met. The Head of Medical Claims is also responsible for staffing requirements, team development, and implementing strategies to enhance efficiency and service objectives.

Main Responsibilities:
Claims Management:
• Demonstrate excellent knowledge of all products administered by the organization, including coverage, benefits, and claims adjudication process details.
• Review adjudicated claims reports before sharing them with service providers.
• Lead efforts to reduce rework, including resubmissions, adjustments, appeals, claim disputes, and encounter reversals through root cause analysis.
• Clarify any queries received from service providers regarding adjudicated claims.
• Take the lead role in managing any new projects assigned to the Claims Department.
• Collaborate with cross-functional teams to ensure successful project implementation and delivery.
• Oversee department workflow procedures and actively participate in cross-functional meetings to identify areas for improvement and implement changes.
• Develop, implement, and monitor reporting mechanisms to oversee department activities and identify trends for expense reduction.
• Ensure accurate and timely completion of reports and other data as requested.
• Operations:
• Understanding of the local healthcare provider network and relationships with hospitals, clinics, and other healthcare facilities.
• Implement new strategies and initiatives to improve departmental performance, focusing on turnaround time, quality, and productivity.
• Oversee the smooth day-to-day operations of the Claims Department, ensuring timely and accurate claims adjudication.
• Collaborate with the IT Department to address claim submission and payment resolution issues with providers.
• Coordinate efforts and resources with other departments to ensure smooth operations and a seamless customer experience.
• Lead the development and refinement of policies, procedures, processes, and workflows to improve service delivery, member and provider satisfaction, and consistency of customer interactions across product lines.
• Identify and resolve problem accounts with providers, investigating and correcting errors, following up on missing account information, and resolving past-due accounts.
• Complete assigned projects and duties as required.

Audits and Compliance:
• Continually review and update policies to align with regulatory requirements and industry best practices.
• Prepare materials for internal and external audits related to claims processes and documentation.
• Ensure adherence to compliance guidelines and regulatory requirements in claims operations.
• Leadership & Culture:
• Provide suggestions and recommendations regarding the staffing requirements of the Claims Department.
• Responsible for the training and development of the Claims Department, ensuring that all team members possess the necessary skills and knowledge to perform their roles effectively by providing ongoing coaching, mentoring, and skill development opportunities to each team member.
• Conduct regular performance evaluations, set goals, and provide feedback to enhance individual and team performance.

Key Competencies:
• Strong leadership and people management skills.
• Excellent problem-solving and decision-making abilities.
• Effective communication and interpersonal skills.
• Analytical thinking and attention to detail.
• Proactive and results-oriented mindset.
• Ability to work under pressure and meet deadlines.
• Strong knowledge of claims processes and regulations.
• Proficient in using relevant software and systems.
• Ability to adapt to changing industry trends and organizational needs.

Academic Qualifications
• Must hold a Degree in Medicine, Health Care Management or any related course from a recognized University.
• Master's degree or professional certification in a related field is preferred.
• Relevant Experience:
• Minimum of Five (5) years’ experience in a similar role is an added advantage.
• Three years’ experience working as a claims team leader in a busy insurance environment is an added advantage.


Work Hours: 8

Experience in Months: 36

Level of Education: Bachelor Degree

Job application procedure

If you are qualified and seeking an exciting new challenge, please apply via jhicu-recruitment@jubileeuganda.com  quoting the position in the subject line not later than 5:00Pm on Tuesday, 13th June, 2023.

Only shortlisted candidates will be contacted.



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