Claims Executive at International Health Management Services (IHMS)

IHMS is a national Health Maintenance Organization (HMO) established in 2001 to provide Social Health Insurance cover to individuals and groups under the National Health Insurance scheme and private health insurance services to interested individuals and groups. It is owned by medical practitioners and Institutional investors.

Job Description

• Receives and registers claims
• Input vetted claims and prepares them for approval
• Forward approved Claims to Team Lead for review and final approval
• Receives and registers encounter data
• Assisting the claims manager in preparing payment analysis for claims on the NHIS and private scheme
• Respond to queries and concerns relating to the claims department
• Decline fraudulent Healthcare Providers’ Claims, and state causative reasons
• Escalate fraudulent claims to the Head of the Department
• Investigate complicated Claims by speaking to Enrollees and providers
• Investigate complicated Claims and escalate to the Team lead, if necessary.

Qualifications and skills

• Must be a registered Nurse/Midwifery
• Minimum of 2 years experience as a Health Insurance Claims Assessor
• HMO Experience in a similar role is an added advantage
• Excellent numeracy, analytical and problem-solving skills
• Strong ability to make a judgment on medical/surgical cases in relation to enrollee’s benefits
• Ability to make a professional judgment on coverage and non-coverage of care requests per time
• Excellent interpersonal and communication skills

Method of Application | Claims Executive at International Health Management Services (IHMS)