Assistant Provider Reconciliations Officer
2025-05-29T14:55:57+00:00
NationHealth Insurance Management Authority (NHIMA)
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FULL_TIME
Lusaka
Lusaka
10101
Zambia
Healthcare
Healthcare
2025-06-10T17:00:00+00:00
Zambia
8
Key Responsibilities
Job Purpose & Scope:
The main role of the jobholder is to manage Health Care Providers claims and Finance/payment reconciliations by ensuring timely claim payments and reconciliations and identifying and correcting any discrepancies. The role will also be responsible for receiving and admission of claims in the claims register and ensuring timely correspondence with Health Care Providers on any omissions that are picked before claims are admitted on the claims register.
Principle Accountabilities:
Principle Accountabilities for this role include but are not limited to the following:
1. Claim settlements and reconciliations (40% weight)
- Having knowledge and understanding of computer and the current insurance system in use, minimum requirement for a fully documented claim, claims protocols and procedures, and NHIMA Benefits and applied tariffs.
- To verify totals on the received invoices and inform Health Care Providers by e- mail/letter of any differences by matching statements from Health Care Providers with batches on the claims register and physical claims
- Reconcile balances between Health Care Providers and NHIMA and maintain files for each Health Care Provider for returned bills to have quick and efficient access to HCP Queries
- To reconcile all payments with Health Care Providers within 90 days of receiving settlement cheque/transfer advice; Health Care Providers are required to re-submit returned/suspended claims requiring additional/missing information within 15 days of advice and the job holder will be required to ensure that this is adhered to.
- Follow up reconciliation statements submitted on a month-by-month basis
- Prepare updated reconciliation statements for HCP Accounts on a weekly basis and submit Weekly, monthly, quarterly and adhoc reports to Supervisor.
- Preparation of Individual HCP Quarterly Reconciliation statements and submit to HCP after verification with Supervisor, every quarter and reconcile accounts within 15 days of submission to HCP.
- Sign off accounts once reconciliation is agreed and completed and maintain report on
Health Care Providers’ Sign offs for due reference as required
2. Health Care Provider Customer Care & Preliminary Claims Preassessment (60% weight)
- Receive claims from Health Care Providers and conduct quality check/preliminary claims assessment for obvious omissions immediately on submission for physically delivered claims and within 5 days for couriered and SFTP uploaded claims
- Maintain emerging issues tracker to be shared as part of weekly reports for due intervention
- Ensure any picked submission omissions are communicated to Health Care Providers within 10 days from received date
- Admit all qualifying claims in the claims register immediately on receipt
- Maintain good business relationship with Health Care Providers and conduct Health Care Provider sensitization on NHIMA Benefits, Tariffs, and importance of properly filled in claim forms
- Post adjudication and post payment, actively timely engage Health Care Providers on claims submission omissions, incomplete and rejected claims, to avoid unnecessary disputes and disruptions in service provision due to non-payment of such claims.
- Maintain regular contact with Health Care Providers and any unpaid bills should be advised to the Health Care providers within 15 days after payment remittance notification by Finance.
- Participate in any other claims process roles as demand arises and as guided by the Supervisor
- Conduct any other roles as assigned by the Supervisor
Education Requirements
- Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language.
- First Degree in any field.
- Certificate or Diploma in Health Insurance, Clinical Health related field, Compensation fund or social security will be an added advantage.
Required Skills
- 3-5 years in a similar role,
- Excellent knowledge of marketing and customer service,
- Good oral and written communication skills,
- Must be computer literate with MS Office applications skills,
- Attention to detail, and Excellent analytical skills
Principle Accountabilities for this role include but are not limited to the following: 1. Claim settlements and reconciliations (40% weight) Having knowledge and understanding of computer and the current insurance system in use, minimum requirement for a fully documented claim, claims protocols and procedures, and NHIMA Benefits and applied tariffs. To verify totals on the received invoices and inform Health Care Providers by e- mail/letter of any differences by matching statements from Health Care Providers with batches on the claims register and physical claims Reconcile balances between Health Care Providers and NHIMA and maintain files for each Health Care Provider for returned bills to have quick and efficient access to HCP Queries To reconcile all payments with Health Care Providers within 90 days of receiving settlement cheque/transfer advice; Health Care Providers are required to re-submit returned/suspended claims requiring additional/missing information within 15 days of advice and the job holder will be required to ensure that this is adhered to. Follow up reconciliation statements submitted on a month-by-month basis Prepare updated reconciliation statements for HCP Accounts on a weekly basis and submit Weekly, monthly, quarterly and adhoc reports to Supervisor. Preparation of Individual HCP Quarterly Reconciliation statements and submit to HCP after verification with Supervisor, every quarter and reconcile accounts within 15 days of submission to HCP. Sign off accounts once reconciliation is agreed and completed and maintain report on Health Care Providers’ Sign offs for due reference as required 2. Health Care Provider Customer Care & Preliminary Claims Preassessment (60% weight) Receive claims from Health Care Providers and conduct quality check/preliminary claims assessment for obvious omissions immediately on submission for physically delivered claims and within 5 days for couriered and SFTP uploaded claims Maintain emerging issues tracker to be shared as part of weekly reports for due intervention Ensure any picked submission omissions are communicated to Health Care Providers within 10 days from received date Admit all qualifying claims in the claims register immediately on receipt Maintain good business relationship with Health Care Providers and conduct Health Care Provider sensitization on NHIMA Benefits, Tariffs, and importance of properly filled in claim forms Post adjudication and post payment, actively timely engage Health Care Providers on claims submission omissions, incomplete and rejected claims, to avoid unnecessary disputes and disruptions in service provision due to non-payment of such claims. Maintain regular contact with Health Care Providers and any unpaid bills should be advised to the Health Care providers within 15 days after payment remittance notification by Finance. Participate in any other claims process roles as demand arises and as guided by the Supervisor Conduct any other roles as assigned by the Supervisor
Excellent knowledge of marketing and customer service, Good oral and written communication skills, Must be computer literate with MS Office applications skills, Attention to detail, and Excellent analytical skills
‘Grade twelve (12) School certificate or its equivalent with 5 merits which should include English Language and Mathematics; Minimum of a Diploma in Human Resource Management or any related field with five (5) years of working experience in a similar role; or a Degree in Human Resource Management or any related field with at least three (3) year of working experience in a similar role; and Preferably experienced working in a Project Closeout environment A Member of Zambia Institute of Human Resource Management.
JOB-6838757d53040
Vacancy title:
Assistant Provider Reconciliations Officer
[Type: FULL_TIME, Industry: Healthcare, Category: Healthcare]
Jobs at:
NationHealth Insurance Management Authority (NHIMA)
Deadline of this Job:
Tuesday, June 10 2025
Duty Station:
Lusaka | Lusaka | Zambia
Summary
Date Posted: Thursday, May 29 2025, Base Salary: Not Disclosed
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JOB DETAILS:
Key Responsibilities
Job Purpose & Scope:
The main role of the jobholder is to manage Health Care Providers claims and Finance/payment reconciliations by ensuring timely claim payments and reconciliations and identifying and correcting any discrepancies. The role will also be responsible for receiving and admission of claims in the claims register and ensuring timely correspondence with Health Care Providers on any omissions that are picked before claims are admitted on the claims register.
Principle Accountabilities:
Principle Accountabilities for this role include but are not limited to the following:
1. Claim settlements and reconciliations (40% weight)
- Having knowledge and understanding of computer and the current insurance system in use, minimum requirement for a fully documented claim, claims protocols and procedures, and NHIMA Benefits and applied tariffs.
- To verify totals on the received invoices and inform Health Care Providers by e- mail/letter of any differences by matching statements from Health Care Providers with batches on the claims register and physical claims
- Reconcile balances between Health Care Providers and NHIMA and maintain files for each Health Care Provider for returned bills to have quick and efficient access to HCP Queries
- To reconcile all payments with Health Care Providers within 90 days of receiving settlement cheque/transfer advice; Health Care Providers are required to re-submit returned/suspended claims requiring additional/missing information within 15 days of advice and the job holder will be required to ensure that this is adhered to.
- Follow up reconciliation statements submitted on a month-by-month basis
- Prepare updated reconciliation statements for HCP Accounts on a weekly basis and submit Weekly, monthly, quarterly and adhoc reports to Supervisor.
- Preparation of Individual HCP Quarterly Reconciliation statements and submit to HCP after verification with Supervisor, every quarter and reconcile accounts within 15 days of submission to HCP.
- Sign off accounts once reconciliation is agreed and completed and maintain report on
Health Care Providers’ Sign offs for due reference as required
2. Health Care Provider Customer Care & Preliminary Claims Preassessment (60% weight)
- Receive claims from Health Care Providers and conduct quality check/preliminary claims assessment for obvious omissions immediately on submission for physically delivered claims and within 5 days for couriered and SFTP uploaded claims
- Maintain emerging issues tracker to be shared as part of weekly reports for due intervention
- Ensure any picked submission omissions are communicated to Health Care Providers within 10 days from received date
- Admit all qualifying claims in the claims register immediately on receipt
- Maintain good business relationship with Health Care Providers and conduct Health Care Provider sensitization on NHIMA Benefits, Tariffs, and importance of properly filled in claim forms
- Post adjudication and post payment, actively timely engage Health Care Providers on claims submission omissions, incomplete and rejected claims, to avoid unnecessary disputes and disruptions in service provision due to non-payment of such claims.
- Maintain regular contact with Health Care Providers and any unpaid bills should be advised to the Health Care providers within 15 days after payment remittance notification by Finance.
- Participate in any other claims process roles as demand arises and as guided by the Supervisor
- Conduct any other roles as assigned by the Supervisor
Education Requirements
- Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language.
- First Degree in any field.
- Certificate or Diploma in Health Insurance, Clinical Health related field, Compensation fund or social security will be an added advantage.
Required Skills
- 3-5 years in a similar role,
- Excellent knowledge of marketing and customer service,
- Good oral and written communication skills,
- Must be computer literate with MS Office applications skills,
- Attention to detail, and Excellent analytical skills
Work Hours: 8
Experience in Months: 36
Level of Education: bachelor degree
Job application procedure
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