Manager, Claims & Provider Relations

SUMMARY OF DUTIES

• Supervision and leadership of the Claims & Provider Relations Team.
• Ensure claims are processed in accordance with established client service level agreements.
• Ensure that pre-authorization requests are processed in accordance with established service guidelines.
• Maintain and monitor the provider network in accordance with established company KPIs.
• Conduct routine and ad hoc audits as and when required.
• Establish and update the department's SOP and processes.
• Prepare reports and attend meetings as and when required.

QUALIFICATION & EXPERIENCE

• First Degree in Management Studies, Business Administration or related discipline.
• At least 5 years' management experience in the health insurance industry in a similar capacity.
• Adept in Microsoft Office Suite (with emphasis on Microsoft Excel)
• Health Insurance Associate (HIA) Designation.
• Life Office Management Association Certification (Parts i and ii)
• Must own and operate a reliable motor vehicle.