About US:
Marie Stopes International (MSI) is a global non-profit organisation providing personalised contraception and safe post-abortion care services to women and girls. Our local teams of professionals are passionate about the work they do in communities across 37 countries. The services we provide give a woman the power to choose when she has children so that she is free pursue her plans and dreams for herself and her family.
Job Summary: The Voucher Claims Officer will primarily verify all voucher claims entered into the claims processing platform to support the timely reimbursement of reproductive health services delivered by the voucher service providers. The claims processing platform uses unique serial numbers and barcodes on vouchers along with customized claim processing software to promote best-in-field voucher management. Claims Officers are expected to assess the validity of claims from a broader medical perspective and identify claims with inconsistencies between sound medical practice and services delivered. The Claims Officers are responsible for technical and in-depth analysis of each claim in the claims processing system in order to accurately approve quarantine or reject payment. All decisions taken by Claims Officers must be medically evidence based and clearly documented in the system. Claims Vetting Officers are also expected to investigate all quarantined claims directly with the service provider and gather sufficient evidence to subsequently approve or reject the claim. Performance will be measured by the number of claims vetted and the integrity of data input in the system to support or reject claims. Claims Officers are expected to work in close collaboration with the finance team, service providers and voucher processing team to facilitate an effective and efficient payment process.
Key Duties and Responsibilities:
1. Provide technical analysis of all claims in the system for approval, quarantining or rejection of claims.
· Work closely with service providers to further investigate abnormal claims from a medical perspective using an evidence-based approach.
· Actively monitor for patterns and reoccurrences of abnormal claims and identify capacity gaps in service provider’s knowledge and claims reporting.
· Compile and submit vetting reports for the finance team to guide claims payments.
2. Technical analysis of all claims in the system for approval, quarantining or rejection of claims
· Routinely evaluate each claim from a logical, medical and technical perspective
· Match the cost of claims against services provided
· Identify claims with abnormalities for quarantine and record supporting evidence
· Reject incomplete claims with supporting documentation
3. Liaise with service providers to further investigate abnormal claims from a medical perspective using an evidence based approach
· Conduct calls or visits to service providers with quarantined claims to collect further evidence supporting their claims, such as client records
· Guide providers on submitting future claims correctly
· Manage and handle all data with confidentiality and ensure all data protection mechanism are strictly adhered to
4. Monitor for patterns of abnormal claims and identify capacity gaps in service provider’s knowledge and claims reporting:
· Compare new claims against historical claims from providers to uncover repeated incidences of claim issues
· Report recurrent issues to a superior with supporting evidence
5. Generate vetting reports for the finance team to guide claims payments: Generate monthly reports for the finance team with clear guidance on which claims to process for payments and which claims to reject
Qualifications, Skills and Experience:
· The ideal candidate should preferably hold a Diploma / Certificate in Midwifery
· At least one year’s work experience in a busy environment
· Computer literacy skills i.e. proficiency in MS Office Packages
· Past experience in operating various work-processing software, spreadsheets, and database programs
· Prior medical experience, particularly in midwifery is desirable
· Proven ability to maintain high levels of confidentiality
· Excellent communication skills
· Good ability to work well in a team
The Voucher Claims Officer is required to demonstrate MSI Uganda’s core values of:
· Accountability of all staff to each other and our clients and stakeholders
· Equality of opportunity and access
· Value for money in the management of our resources
How to Apply:
All suitably qualified and interested candidates are encouraged to send their electronic applications including a cover letter, updated CV and academic documents via E-mail to: jobs@mariestopes.or.ug.
Deadline: 21st August, 2015