Risk Assessor

Zimbabwe·Hararemid

OtherRisk

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Quick Summary

Overview

Reporting to the Senior Risk Health and Wellness Officer The main responsibilities of the job are: Reviewing claims to identify errors, fraud, and trends. Pre-authorizing hospital admissions and monitoring member benefits.

Requirements Summary

Diploma in Nursing (Please note that a Nursing background is a must). Diploma or Degree in Insurance and Risk Management, or equivalent, is an added advantage. Diploma in Theatre Nursing and/or Midwifery is an added advantage.

Technical Tools

OtherRisk

Responsibilities

~1 min read

Reviewing claims to identify errors, fraud, and trends.
Pre-authorizing hospital admissions and monitoring member benefits.
Registering and following up with patients enrolled in the chronic disease management program.
Conducting workplace-based wellness programs for corporate clients.
Investigating service providers and members with suspicious claiming patterns.

Requirements

~1 min read

Diploma in Nursing (Please note that a Nursing background is a must).
Diploma or Degree in Insurance and Risk Management, or equivalent, is an added advantage.
Diploma in Theatre Nursing and/or Midwifery is an added advantage.

Have at least 2 years’ experience in claims investigations, case management, and implementation of wellness programmes within a medical aid environment.
Possess excellent investigative, problem-solving, and decision-making skills.
Demonstrate a strong client focus.
Have good written and verbal communication skills.
Be a person of integrity, with the ability to handle sensitive information confidentially and transparently.