Benefits & Claims Officer at National Health Insurance Management Authority

The National Health Insurance Management Authority (NHIMA) is a body corporate established under the National Health Insurance Act No 2 of 2018. The Act’s primary mandate is to provide for sound financing for the national health system in order to provide universal access to quality insured health services to all Zambians.

In fulfilling this mandate, the Authority now requires the services of;

Benefits & Claims Officer

Principal Accountabilities:

The role will be responsible for the day to day management of claims from health care providers, ensuring that claims are paid timeously and in accurate amounts. It will also be responsible for ensuring that the health care providers are providing the health care services to the members of the Scheme in line with their Benefit Package.

Primary Responsibilities

The primary responsibilities of the role will be;

• To receive, process and pass on all claims for prompt payment;
• Analyse claims and determine whether they are covered by the Scheme in line with the Benefit Package of the member;
• To resolve all queries from members and health care service providers in line with internal processes and turn around targets;
• To escalate all other matters as may be pertinent in line with the internal escalation processes;
• To prepare status reports on the payment of claims and member access to benefits to ensure gaps are quickly identified and addressed timeously; and
• To perform any other role as may be assigned from time to time

Educational Qualifications;

• Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language;
• First Degree in any field; and
• Certificate in management of a health insurance scheme, compensation fund or social security will be an advantage.

Relevant Experience and other Attributes;

• 3-5 years of experience in a similar role;
• Good understanding of insurance principles;
• Good oral and written communication skills;
• Must be computer literate with good appreciation of MS Office applications;
• Attention to detail; and Excellent analytical skills;

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