Applications are invited from suitably qualified and experienced persons to fill the above vacancy that has arisen within First Mutual Health Company. The incumbent will be responsible for developing, implementing and maintaining an effective claims adjudication process, fraud waste, and abuse process as well as client and service provider engagement. The Job Reporting to the Operations Executive, the successful candidate will be responsible for the following: • Implementing the claims strategy adopted for the company • Providing input into the claims strategy and policy • Compiling the revenue, general expenses and CAPEX budget for the Claims Adjudication Team • Ensuring profitability of First Mutual Health Clinics and Medical centres • Responsible for tariff negotiations with service providers • Assessing high value and difficult medical claims • Monitoring claims and investigating sources of variances if any, to the set claims ratio • Implementing company projects which fall under the claims department • Implementing the fraud, waste and abuse strategy for the company • Accrediting and terminating service providers
The Person The ideal candidate must possess the following: • Degree in Medicine • Business qualification would be an advantage • Must possess an open practicing licence • Strong Medical Claims Management background • 4 years' experience in Medical field • 2 years post housemanship experience • Operational and Clinical Claims Management experience is an added advantage • Commercial thinking and business acumen • Must demonstrate expert-level knowledge and awareness of stakeholder relationship management
Candidates meeting the above criteria should forward their Curriculum Vitaes (CVs) and application letters to Group Human Resources via the following email address email@example.com. Applications should be sent by and not later than Wednesday 23 October 2019 and should have the position being applied for in the subject line.