Junior Claims Assessor

ABOUT CAREPAY:
In 2015, the CarePay platform launched the mobile health wallet under the brand M-TIBA in Kenya. Combining mobile technology and -money so people could save up for future hospital expenses. Since then the platform grew to become the digital connector between the healthcare payers, providers, and members. Covering the end-to-end health insurance journey while always keeping the individual's perspective in mind first. The platform improves the way money flows through the healthcare system, lowering the costs society must pay to get access to good quality healthcare. CarePay is at the forefront of revolutionary technological and social impact within healthcare, improving the lives of millions around the world.

In 2019, CarePay raised $45 million in growth capital in its Series A financing round, becoming one of the best funded start-ups in Africa in 2019. Quickly after, the company was internationally recognized as #7 on Fortune's Change the World 2020 list alongside Alibaba, Paypal and Zoom.Currently, CarePay has over 4.8 million people registered, 20+ Payers and 5,000+ healthcare providers connected to their platform. Following the success of M-TIBA in Kenya, CarePay has established its headquarters in Amsterdam, with the aim of scaling the platform to other countries. The company has already begun its international expansion.

MAIN PURPOSE OF THE JOB:

The Junior Claims Assessor will have the responsibility of ensuring that medical claims and cases are vetted and that they meet the set objectives for a given project. The position will also involve giving detailed reporting on all the general findings from the claims or cases vetted with the aim of improving project outcomes as well as enhancing system functionality.

KEY DUTIES AND RESPONSIBILITIES:

• Verify and analyze all data on claims or cases and ensure these meet the project objectives as well as payer expectations for the various projects.
• To send back simple yet detailed feedback to the provider team where claims do not meet the project expectations.
• To ensure any general trends or inconsistencies noted are reported to the operations and provider teams.
• Timely assessment of claims re-submitted by the providers, ensuring the queries raised are understood, and following up with the provider team to ensure they are resolved.
• Provide support to the customer call center to address medical queries that have been escalated to CarePay.
• Document and be able to extract, present, or discuss provider practices or disease trends.
• Deliver feedback and training aimed at addressing the trends picked from the claims assessment exercise.
• Mapping generic rules to medical services, procedures, drugs and lab tests.
• Participate in testing and documentation of selected CarePay systems.
• Perform all other duties as assigned by the supervisor.

EDUCATIONAL QUALIFICATIONS, KNOWLEDGE & EXPERIENCE:

• Degree/ Diploma in Clinical Medicine or Nursing
• Good understanding of private and public healthcare delivery.
• Have a strong understanding of medical treatment protocols and cost-effective prescribing habits in relation to market segmentation.
• At least 2 years' experience in a busy hospital set-up
•  Experience in insurance will be an added advantage.

KEY SKILLS AND COMPETENCIES:

• Good analytical and problem-solving skills.
• Excellent oral and written communication skills.
• Strong interpersonal skills with ability to work with cross-cultural and diverse people and teams..
• Collaboration and team working skills.
• Customer service skills.
• Data Entry skills with ability to produce accurate work.
• Reporting and good attention to details.
• Ability to prioritize and work to meet deadlines.
• Flexible and ability to adapt or change to new situations and handle high levels of uncertainty.
• Ability to maintain confidentiality.
• Personal qualities of integrity, credibility, professionalism, and a commitment to CarePay's mission.

CarePay is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, family, gender identity, genetic information, marital status, race, religion or any other characteristic protected by applicable laws, regulations and ordinances.