About US:
UAP Holdings Limited is the pan-African Financial Services Company with a primary purpose of acting as a holding company for the various UAP businesses. The Group’s origins in Kenya date back to the 1920’s when Provincial Insurance Company of East Africa was incorporated. UAP Group embarked on a multi-phased restructuring plan in 2006 to shift from a traditional non-life insurance business to a broad-based Insurance and Financial Services Group. UAP Group has grown into a Pan-African Financial Services Group with a geographical footprint in six (6) countries namely Kenya, Uganda, South Sudan, Rwanda, Tanzania and Democratic Republic of Congo (DRC). The range of services and products have grown beyond General Insurance to include Life Assurance, Property Investments, Fund Management and related Financial Services such as insurance premium financing, financial advisory and securities brokerage.
Job Summary: The Medical Claims Manager will ensure control and overseer the medical claims processes and procedures through use of effective techniques to achieve the objectives of claims cost control, operational efficiency and meeting of the customer service charter in claims payment.
Key Duties and Responsibilities:
· Management of the claims process flows to ensure efficiency in processing of claims as per the company medical claims procedure manuals
· In charge of the verification and audit of outpatient and inpatient claims as per the claims manual and customer service charter manual to ensure compliance and mitigate risk.
· Negotiate professional fees and hospital charges including discounts to control expenditure.
· The incumbent will manage the processing, settlement of all claims and authorize requisitions.
· Holding regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs.
· Actively monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers.
· Supervise, train and mentor medical claims staff to achieve a high level of motivation and productivity by the team.
· Prepare regular claims reports to clients, management and advice underwriter health on relevant claims findings for medical risk review.
Qualifications, Skills and Experience:
· The applicant should hold a good Bachelor’s degree qualification preferably in Nursing.
· Possession of a Diploma in Insurance and or a degree in Health systems Management/ Business management will be an added advantage
· A minimum of two years’ experience in clinical setting
· Three years’ experience working as a claims team leader in a busy insurance environment
· Excellent communication and negotiation skills.
· Possess excellent public relations and interpersonal relationship skills.
· Extensive networking with SP and other medical insurers
· Excellent analytical and monitoring skills
· User IT skills in database management and office systems.
· Ability to evaluate decisions made in benefit utilization management.
· High degree of integrity and honesty
How to Apply:
All candidates who wish to join the Insurance industry should send their applications via Email with an updated CV and cover letter with the subject head as Claims Manager to: hr@uap.co.ug.
Deadline: Friday, 23rd October, 2015 by 5PM