Medical Assessor at AAR Insurance

Key Responsibilities

• Reviewing, assessing, coding, vetting, approving and processing of all claims.
• Capturing claims master information, claims details/line information and claims reference information ensuring claim is processed against the right benefit type and that the right scheme rules are applied.
• Detecting any fraudulent claims e.g. overpricing of items or services, overprovision of services and scheme abuse practices.
• Communicating part payments and their reasons to providers in advance through the provider management team.
• Auditing provider billing practices or high quantity drug reports and advice the claims manager.
• Advising other claims handlers on their cases and act as the focal point for claims requiring medical claims knowledge.
• Identifying the cost drivers and their trends and inform the claims manager with a view to finding solutions to cost containment.
• Responding to internal and external queries in a timely manner.

Education, Experience & Competencies

• Holders of a Diploma or Bachelor’s degree preferable in Nursing or Clinical Medicine
• Possess at least 2 years relevant work experience.
• Holder of a professional certification such as: Insurance professional qualification i.e. AIIK or ACII.
• Possess excellent interpersonal skills, attention to details and a team player