Core Purpose of the Job

• Responsible for overseeing healthcare provider network development and management, care coordination, provider relations, claims administration, and wellness programs and at the same time ensuring enrollee satisfaction.

Tasks
You are expected to contribute meaningfully towards team target achievement.

• Oversee member services activities and client relationship management.
• Assist in the marketing of health plans to private and public organizations by developing training materials, conduct onsite training sessions, circulate health newsletters, carryout researches, resolving situations as as raised by enrollees.
• Be responsible for general administration, appropriate adjudication, negotiation of claims.
• Timely treatment of pre-authorization requests and codes.
• Sufficient and effective deployment of monitoring/quality assurance tools.
• Effective provider visitation and proper reporting of visits and Quality Assurance tools utilized in weekly report.
• Effective use of computer to analyze report and submit reports.
• Ensure confidentiality of Client records.
• Coordinate medical reviews, grievances and appeals.
• Ensure seamless operations in the provision of care to enrollees.

Job Specific Competencies (Skills/ Knowledge/ Attributes)

• Ability to develop, influence and implement systems and procedures.
• Possess excellent verbal, written and presentational skills.
• Excellent analytical skills.
• Knowledge of project management techniques.
• Ability to work under pressure.
• Must possess excellent time management skills.
• Business minded with a focus on developing creative solutions.
• Ability to use discretion.