Health Claims Manager

This role ensures accuracy, efficiency, and compliance with relevant policies and regulations.

The Health Claims Manager is responsible for overseeing the health claims processing operations. 

This role ensures accuracy, efficiency, and compliance with relevant policies and regulations.

Main Responsibilities

Claims Processing:

• Supervise and manage the end-to-end process of health claims.

• Ensure claims are processed accurately and in a timely manner.

• Review and resolve complex or high-value claims.

Compliance and Regulation:

• Ensure all claims processing adheres to regulatory requirements and company policies.

• Stay updated on industry regulations and adjust processes as necessary.

• Conduct regular audits of claims and processes to ensure compliance

Team Management:

• Lead and mentor the claims team.

• Develop training programs for new and existing staff.

• Manage performance evaluations and provide constructive feedback.

Customer Service:

• Address escalated issues and complaints from clients or healthcare providers.

• Implement strategies to improve client satisfaction and resolve disputes effectively.

Reporting and Analysis:

• Prepare and analyze reports on claims trends, performance metrics, and financial impacts.

• Identify areas for process improvement and implement solutions.

• Develop and monitor key performance indicators (KPIs) for the claims department.

Collaboration and Communication:

• Coordinate with other departments (e.g., finance, client management, HR, Legal and Compliance, IT) to streamline processes.

• Communicate effectively with healthcare providers, insurance partners, and stakeholders.

Technology Management:

• Oversee the use of claims management software and technology systems.

• Ensure data integrity and security within the claims processing system.

Job Requirements Qualifications:

• Ideally a Bachelor’s degree in particular in Healthcare Administration, Business Administration, or related field. A professional certification (e.g. Nursing, IT coding...) would be a plus.

Alternatively:

• Proven experience in a health claims department for at least 8 years.

• Experience in a supervisory or managerial role mandatory.

Technical Skills:

• Proficiency with claims management software and Microsoft Office Suite.

• Strong understanding of healthcare regulations, coding, and billing practices.

Analytical Skills:

• Ability to analyze complex data and generate actionable insights.

• Strong problem-solving skills and attention to detail.

Communication Skills:

• Excellent verbal and written communication skills.

• Ability to effectively present information and respond to inquiries from clients, higher management and stakeholders.

The company reserves the right to call only the qualified candidates for the selection exercises. Applications received after the closing date might not be considered. The company also reserves the right not to proceed with the vacancies.