Resolution Health East Africa Limited is a leading Medical Insurance Provider. With over 60,000 members
in our fold, we have learnt to adapt in this constantly changing society, and develop products that are
effective and relevant to our members. Resolution Health has over 250 medical service providers all across
East Africa, a strong network of hospitals, clinics and doctors.
The role of the Relations Executive is to maintain a good working relationship with our Medical Service
Providers (MSPs) by following up on disputed claims to ensure the delivery of quality health care is to the
satisfaction of members.
Key Outputs
- Sets up new MSPs, establish and maintains proper coding and data per supplier requirements;
- Maintains effective and ongoing communication within the office and with outside parties on
- provider issues;
- Maintains various claims processing and procedure records necessary for provider management;
- Ensure timely follow up and resolution of claims in dispute;
- Provides assistance and support for internal staff in relation to MSP queries;
- Routine counter checking of undelivered claims against:Transaction lists RHEAL claims record
- Follow up on Credit Notes;
- Produce weekly reports on disputed claims stating reasons for rejection/deferrals;
- Prepare monthly MSP reconciliations;
- Handle claims queries and correspondence with service providers relating rejected/deferred
- claims;
- Provide regular unresolved claims reports;
- Performs other support functions as part of the general office operation as directed by Manager
- and/or Supervisor ;
- Degree in a Business field
- Accounting knowledge an added advantage
- Knowledge of Microsoft Office with excellent skills in Excel
- 3 years working experience in a related position
- Proficiency in driving with a valid driving License
- Timeliness of completing tasks/assignments and complying with requirements are essential
- Outstanding communication skills – both verbal and written – as communication and the sharing
- of information internally and externally is essential
- Exceptional commitment to customer service
- Ability to operate in a team environment with the expectation of enhancing and contributing to
- the offices’ overall effectiveness and success
- Good analytical and problem solving skills
- organized, able to prioritize work
email your detailed CV stating your day time telephone contacts not later than Friday 8th April 2011 to
hr@resolution.co.ke
Kindly ensure you quote the position on your email
Only shortlisted candidates will be contacted
My Health, My Life, My Resolution
www.resolution.co.ke
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