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Claims Assessor – Reconciliations and Payments
Job Ref. No: JHIL081
Role Purpose
- Evaluate and assess insurance claims, ensuring accurate reconciliation of claims data and timely payment processing. The job holder will be responsible for analyzing claim information, reconciling claims against policy provisions, verifying payment calculations, and facilitating the payment process. The role involves collaborating with various internal departments and external stakeholders to ensure efficient and accurate claims reconciliation and payment management.
Main Responsibilities
Operational
- Assess claims to ensure details are captured correctly. Member name, policy details, on the claim form match with invoice details.
- Invoiced amounts on invoices, letter of undertaking and other documents submitted are similar in the system.
- Review of declined and part paid claims.
- Hold meetings with service providers to discuss clinical issues in a view of aligning with industry practices.
- Confirm membership validity and benefits before processing claims.
- Review patients’ history and records to determine cause of disease or disorder and assess if treatment and prescription recommended correlates with the diagnosis.
- Confirm that treatment given is in adherence to provider panel rules of eligibility as well as customary and reasonable pricing.
- Provide training and guidance to team members on emerging issues around claims assessment.
- Identify fraudulent claims with an aim to reduce claims costs and enable prudent benefit management for members.
- Advise on any emerging fraudulent trends on providers during adjudication and any other improvements in processing of claims.
- Respond to service providers queries on any part payments and declined bills.
Corporate Governance
- Ensure compliance with company policies, procedures, and regulatory guidelines.
- Maintain confidentiality and handle sensitive information in accordance with privacy laws and regulations.
- Adhere to ethical standards and maintain professional conduct while dealing with confidential or sensitive matters.
Leadership & Culture
- Engaging in ongoing professional development activities to enhance knowledge and skills in claims assessment, reconciliation, payment processing, regulatory compliance, and corporate governance.
- Foster effective working relationships with internal stakeholders, such as underwriting, claims, finance, and actuarial teams, to ensure alignment and collaboration in medical accounting activities.
- Foster a culture of accountability and responsibility within the claims function.
- Serve as a role model for exceptional customer service and professionalism.
- Change Management: Assist in driving change initiatives within the claims team and the broader organization. Help team members adapt to changes and foster a culture of agility and continuous improvement.
Key Competencies
- Analytical Thinking
- Attention to Detail
- Effective verbal and written communication
- Problem-Solving
- Customer Focus
- Compliance Knowledge
- Time Management
- Teamwork
Qualifications
- Bachelor’s degree in nursing
- Good understanding of the concepts of medical insurance
- Proficient in the use of Microsoft office suite and packages
- Proficient in the use of Actisure
Relevant Experience
- 3 years’ experience in claims assessment in the insurance industry
Closing- 13th July 2023.
Independent Financial Advisors (IFA)
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Job Ref. No: JAML004
Role Purpose
- To provide Professional Investment Advisory Services to our clients within the Retail, High Net worth & Institutional segments. The successful candidate will be responsible for sourcing, retaining, and growing a client base by implementing financial planning solutions in line with the client’s needs. The role holder will be required to be up to date with macro economic trends, market developments as well as monitoring corporate actions of listed companies.
Main duties and responsibilities:
- Meeting clients to understand their financial objectives by selling & cross selling of all JAML Investment products and services.
- Managing, maintaining, and building new and existing client relationships.
- Preparing and presenting proposals to existing and potential clients
- Provide direct sales support (quality lead generation and effective follow-up) to generate and convert quality leads into sales.
- Participate in specific product campaigns by ensuring that the products are explained to customers.
- Adhering to compliance, operational procedures, and practice management standards.
- Assists clients grow their investment portfolios by giving them the right advice on where to invest the money for maximum returns while reducing risk.
- Asks clients pertinent questions to understand their financial goals to advise them correctly on what investment options to take.
- Complies with all regulatory requirements in offering advice to clients to avoid penalties from regulators.
- Consistently achieving the allocated sales targets.
Key Competencies
- Prospecting skills
- Personal Branding & Good communication skills
- Social Selling & Negotiation skills
- Virtual Selling Skills
- Able to work independently
- Relationship management and networking skills
- Able to plan and manage time effectively
- Strong negotiation skills are required.
- Ability to understand economic and financial trends is a requirement.
- Ability to work under pressure.
Qualifications
- Bachelor’s Degree/Diploma/Certificate in relevant field.
- Any Professional Certificate in Insurance or Investments will be an added advantage.
- Investment industry knowledge Mandatory.
Relevant Experience
- Minimum of 3 years’ sales experience in the Financial Services industry selling investment products or Insurance products.
Closing – Monday, 25th July 2023.