JOB DESCRIPTION

General Information

JOB TITLE: Manager, Claims and Medical
UNIT: Operations
DIRECTLY REPORTS TO: COO
LOCATION: LAGOS

Job Functions


Design and implement various policies and procedures for claims.
Provide services to all business requirements and ensure optimal handling of all claims and investigate all issues and provide training for all business units.
Evaluate all new claims and administer all data integrity data and manage communication to safety department and monitor all claims and ensure timely closure.
Evaluate all business units’ associate claims.
Provide training to juniors to manage all outstanding claims and design an efficient duty program and coordinate with HR team to facilitate same.
Perform regular quarterly audits on all local TPA offices.
Monitor effectiveness of all programs and provide support to all open claim file reviews and manage all payment cycle to ensure compliance to all contract requirements.
Design and maintain panel of investigators to use all TPA and prepare reports for monthly chargeback for all business units.
Analyze all claims to ensure optimal quality and prepare reports for various business units and monitor all chargeback expenses and provide report to all clients and management.
Perform investigation on all reserve increases and perform regular surveillance of all claim issues and maintain efficient location code listing for TPAs.
Schedule all internal and external audits on all claims issues and supervise processing of all billing issues.
Oversee all electronic claims processes and evaluate all self-insurance applications and prepare claims reports and evaluate all actuarial.
Analyze all claims and identify all risks and ensure processing of all claims as per company policy.
Forecast all staffing requirements and identify and resolve all issues effectively.

Relationships:
Head Office-Lagos
Operations Unit
Accounts unit
Medical unit
Enrolment unit
IT unit
Call centre
Internal control/Admin unit

Send your curriculum vitae to recruitment@lifeactionplus.com