Claims Manager Medical Uganda job at Old Mutual

JOB DETAILS:

Job Description
• To ensure that general insurance claims are handled expeditiously and in a professional manner thereby meeting the customer expectations and the Company's Corporate Objectives.
• Constantly monitor the claims processes and procedures are maintained at all times and ensure compliance to QOP and ISO 9001.
• Ensure that quality and timely service is offered to customers and that we maintain a cordial relationship with our customers.
• Constantly review reserves and ensure that adequate the estimates maintained are as accurate as possible and reflect the prevailing economic, legal and social environment.
• Budget sufficient financial resources for the department, monitor and control the internal costs of running and ensure that the department operates within the set budget.
• Oversee the claims process flows to ensure efficiency in processing of claims as per the company medical claims procedure manuals
• Verify and audit of outpatient claims as per the claims manual and customer service charter manual and customer service charter manual to ensure compliance and mitigate risk
• Negotiate professional fees and hospital charges including discounts to control expenditure
• Overseeing processing, settlement of all claims and authorize requisitions
• Holding regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs
• 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
• Prepare regular claims reports to clients, management and advice underwriter health on relevant claims findings for medical risk review


Underwriter UIC Medical Uganda job at Old Mutual
JOB DETAILS:

Job Description
• To manage underwriting and processing of medical files in line with company policies and procedures.
• Preparation and dispatch of membership cards
• Endorsing and invoicing client accounts
• Timely response to customer within service charter standards
• Ensure completeness of insurance documentations-KYC
• Credit Control
• Update membership data into the medical software system
• Request for membership cards
• Reconcile membership accounts in line with company policies and procedures.
• Prepare reports on endorsement activities (card replacement, card delivery…)
• To oversee Account endorsements (additions, deactivations, card replacements)
• Prepare invoices for premium payment.
• Work closely with the card service provider to ensure card issuance SLA’s are adhered to.
• Generate member statements
• To liaise with intermediaries and maintain positive business partnerships.
• Assist in credit control by ensuring no unpaid business is booked
• New medical scheme set ups- completion of contract files, payments, member lists etc.

Skills
Business, Business Partnerships, Dispatching, Insurance, Invoices, Payments, People Management