Medical Claims Assistant - South Sudan Support

Job Purpose\:
To provide operational support to the South Sudan Medical Business from Kenya by ensuring timely and accurate medical claims processing and reconciliation, strengthening healthcare provider engagement, and driving efficient service delivery. The role aims to enhance client satisfaction and experience, foster effective provider relationships, and promote cost-effective healthcare through proactive claims management, provider coordination, and continuous service improvement.

Key responsibilities
• Posting reimbursements and provider invoice details into the Mashinani System.
• Maintain close contact with appointed health care service providers to ensure strict compliance with agreed procedures and guidelines.
• Ensure that healthcare providers have adequate claim forms to serve members. · Carry out vetting and verification of outpatient and inpatient claims.
• Ensure that the panel of doctors is strictly adhered to by clients and hospitals in order to reduce claims costs.
• Enlisting providers on panel.
• Approval of emails and pre-authorizations within 24 hours for scheduled requests and promptly for emergency approvals.
• Assess medical claims documents for authenticity and process payments within set service levels.
• Maintain accurate records on medical claims.
• Manning of the 24hr helpline.
• Conducting timely and accurate claims reconciliation with healthcare providers, resolving billing discrepancies, and strengthening financial accountability.
• Perform any other duties as may be assigned from time to time.
• Delegated Authority\: As per the approved Delegated Authority Matrix.