Claims Payment Analyst

To ensure accurate, timely, and compliant processing of health insurance claims payments, supporting organizational efficiency and maintaining high standards of service delivery.

Academic/Professional: B. Sc in Accounting, Finance or related field, from a reputable tertiary institution and Data analytics skills, SQL will be an added advantage. 

Work experience: Minimum 0-3 years total work experience with at least 2 in related job role

Job Level: This position has been profiled as a minimum Analyst role owing to the defined skill level, years of experience and complexities of the task to be performed.

Grade Level: This position has been profiled as a minimum Grade Level 8 owing to the defined skill level, years of experience and complexities of the task to be performed.

Key Responsibilities

• Monitor and manage weekly and monthly payment schedules to ensure timely disbursement to healthcare providers and adequate reporting.
• Monitor and pay individual reimbursement claims- Domestic (local) and international products within required turnaround time
• Collaborate with settlement team to ensure prompt and effective outcome.
• Scrutinize or escalate high-value, or suspicious claims as needed.
• Generate regular periodic reports that will provide business intelligence on direct billing claims from Providers and reimbursements to aid efficiency of the team and to provide recommendations to Provider management, Wellness and PBM teams
• Conduct random claim audits to identify patterns and ensure continuous quality improvement.
• Maintain comprehensive and accurate payment records to support audit and compliance requirements.
• Identify gaps or bottlenecks in claims processing and recommend process improvements.
• Utilizes analytical skills to identify problems and proffer solutions within the unit.
• Ensure adherence to internal controls, standard operating procedures, and relevant regulatory guidelines.
• Collaborate with IT and process teams to enhance systems and optimize workflow.
• Work closely on/with claims review team to ensure claims are adjudicated promptly and follow the unit process flow.
• Any other responsibilities that might be required by the Unit Head from time to time
• Automatically assumes responsibility in absence of Line Manager