Manager, Claims & Provider Relations

Job description

SUMMARY OF DUTIES Supervision and leadership of the Claims & Provider Relations Team. Ensure claims are processed in accordance with established client service level agreements. Ensure that pre-authorization requests are processed in accordance with established service guidelines. Maintain and monitor the provider network in accordance with established company KPIs. Conduct routine and ad hoc audits as and when required. Establish and update the department's SOP and processes. Prepare reports and attend meetings as and when required. QUALIFICATION & EXPERIENCE First Degree in Management Studies, Business Administration or related discipline. At least 5 years' management experience in the health insurance industry in a similar capacity. Adept in Microsoft Office Suite (with emphasis on Microsoft Excel) Health Insurance Associate (HIA) Designation. Life Office Management Association Certification (Parts i and ii) Must own and operate a reliable motor vehicle.