Summary
Date Posted: Wednesday, February 28 2024, Base Salary: Not Disclosed

JOB DETAILS:
LOCATION- LUSAKA
REPORTING TO THE MANAGER –CUSTOMER SERVICE CLAIMS & CASE MANAGEMENT
Purpose- Providers Account & Claim Reconciliations & Relationship Management
Essential Duties-
• Plan Hospital Risk and case management visit to familiarize Case Managers with the patient’s condition to be able to do the relevant interventions
• Carry and manage Company emergence line 24X 7. Ensure that Life Quest Tech receives the pre-auth from hospitals
• Accounts reconciliation of claims settlement of all eligible medical claims within agreed service level agreements (SLA) with the network health care providers and Insurers
• To ensure that Health Care Providers are informed in time of the incomplete and hold claims to avoid unnecessary disputes and disruptions in services due to non-payment of claims
• Responsible for managing relationships and monthly billing reconciliations between the accounts dept and various Insurance Companies/ Healthcare Providers to ensure that claim are settled within SLA; send claim settlement advice to the health care providers within 48 hours of receiving confirmation of transfer and sign off on monthly billing basis
• Reconcile of all payments with health care providers within 60 days of receiving settlement transfer advice; health care providers are required to re-submit suspended claims requiring additional/missing information within 30 days of advice and you will be required to ensure that this is adhered to as per SLA

General Duties-
• Ensure that the providers adhere to the Insurer policy cover during the member’s hospitalizations
• Liaise with the network providers to ensure a seamless admission and discharge process of members
• Ensure the member bill are collected from their respective hospital
• Vet all bills as per policy biding the medical scheme at hand
• Be able to submit reports as per SLA of respective clients
• Continuous training and maintaining good relationships with HCP partners
• Maintain patient data & Confidencialty as per Life Quest Tech policy

Key Qualifications:
• Diploma in Nursing or any medical related field
• Mandatory Min 2 years working in any Healthcare with claims background
• High level of healthcare business awareness
• Understanding of the healthcare business strategies, objectives
• Good knowledge of the medical practices, accounting methods
• Mandatory Driver’s license

Personal Attributes:
• High standards of honesty and integrity
• Self-Starter & Highly Innovative
• Resilient and ability to work under pressure
• Passion for and attention to detail
• Pleasant and friendly personality
• Passion for customer/ People care
• Good communicator, both orally and written
• Team Player & Sense of Urgency
• Concern for order and quality
• Mandatory knowledge and understanding of computer and a quick learner insurance operating system

Qualities & Skills Required Undertaking The Role:
• Quantitative/Statistical skills
• Relationship Management Skills
• Good Interpersonal Skills
• Accounting Skills & Analytical & Planning Skills
• Time Management & Negotiation skills
• Planning and Organisation
• Tact and Diplomatic skills
• Computer & Technology savvy

Work Hours: 8

Experience in Months: 24

Level of Education: Postgraduate Degree

Job application procedure
• No constraints for the right candidate or open for discussion
• Note : All applications should be directed Only with cv via email to info@lifequest.co.zm 
Application closing date is 15th March 2024 & Please note that only short-listed
candidates for the interviews will be contacted.
• Life Quest Technologies & Medilink International Group is “an equal opportunity employer”, therefore qualified candidates are encouraged to apply irrespective of gender or disability

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