Head of Claims & Medical Advisor Career Opportunity – IAA Healthcare

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Organisation: IAA Healthcare
Duty Station: Kampala, Uganda
Reports to: General Manager
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).
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 tariff s.
  • 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
  • Tasked with monitoring and improving claims processing turnaround time, practices and procedures
  • Handle clients and service provider complaints
  • Conduct claims control and analysis
  • Actively 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:
  • The applicant must have a Medical Degree with relevant clinical experience plus experience in management.
  • Three years of 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
All candidates should email their application letters, updated CV, copies of certificates including daytime telephone numbers to the Head of Human Resources to iaa@img.co.ug
Deadline: 30th April 2018


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