Total Health Trust Limited (THT), a leading Health Maintenance Organization (HMO) with 18 years industry track record. We are recruiting to fill the position below :

POSITION : Branch Agent (Medical)

RESPONSIBILITIES

• Provide services in the accreditation and re-accreditation of branch providers to ensure that provider facilities and services are up to standard as per the agreed standards using a standardized checklist
• Adhere to and live the organizational values
• Following Head Office approval, to ensure a successful provider forum is held as stipulated
• Ensure provider education is done and ensure product knowledge and processes are understood towards seamless service delivery to enrollees
• Manage specific cases in the branch in order to get the best outcome
• Facilitate the process of pre-authorisations and authorisations between the provider and the scheme and to give feedback to the relevant party concerned
• Facilitate resolution of all queries from providers and members within the branch on specific cases and within the agreed SLA
• Facilitate the investigation of potential fraudulent claims within the specific branch and provide feedback to the Branch manager
• Hospital visits regarding specific branch cases

Requirements

• B.Sc. Nursing and additional medical qualification will be an added advantage
• Minimum of 3 years medical experience including 2 years in similar role in an Health Maintenance Organization (HMO)
• Must have advanced knowledge of NHIS regulatory guidelines, Medical Global Best Practices, Health Insurance, Products and Processes, and Scheme Rules.
• Must be a registered nurse
• Excellent organizational, communication (verbal and written), listening skills and attention to detail.
• Candidate must be very proficient in Microsoft office packages

Others:

• Ability to work under pressure
• Adaptive, expertise, Result-Oriented, Relationship Skill
• Working with people
• Interpersonal Skill
• Must be a good collaborator/Team player
• Good organizational and planning capabilities
• Innovative and quick thinking capabilities
• Adaptive
• Decision Making skill and Excellent Customer Service Skill
• Integrity