Claims Team Leader at METROPOLITAN LIFE BOTSWANA

Closing Date	2024/11/08
Reference Number	MMH241022-5
Job Title	Claims Team Leader
Position Type	Permanent
Role Family	Client Services
Cluster	International
Remote Opportunity	None of the time
Location – Country	Botswana
Location – Town / City	Gaborone
Introduction	Metropolitan Health Botswana is looking for innovative and energetic individuals to fill the position of Claim Team Leader.
Disclaimer	As an applicant, please verify the legitimacy of this job advert on our company career page.
Role Purpose	Reporting to the Operations Manager, the incumbent will be responsible for overseeing effective delivery of claims assessment processes and activities.
Requirements	A Degree in General Nursing or a healthcare related field Registration with the relevant professional body 3-5 years’ experience in a supervisory management role Experience in medical aid or health service environment
Duties & Responsibilities	Lead, motivate, and manage a team of claims assessors to ensure high performance and productivity. Oversee the claims assessment process to ensure accuracy, efficiency, and compliance with scheme policies. Review complex or high-value claims, providing guidance and making final decisions as needed. Ensure that claims are processed within the agreed turnaround times and that any delays are managed appropriately. Implement and maintain quality control procedures to ensure the accuracy and consistency of claims assessments. Conduct regular audits of processed claims to identify errors, trends, or areas for improvement. Handle escalated claims inquiries or complaints from members, healthcare providers, or brokers, ensuring a satisfactory resolution. Prepare regular reports on team performance, claims processing metrics, and quality assurance results for management review. Identify opportunities for process improvements within the claims department and lead initiatives to enhance efficiency, accuracy, and service delivery. Monitor and manage risks associated with claims processing, including fraud detection and prevention. Conduct regular performance reviews, provide feedback, and develop action plans for improvement.
Competencies	Strong leadership skills Strong analytical and problem-solving skills Excellent attention to detail and accuracy Compliance with procedures and deadlines Proficiency in Microsoft Office Suite Good communication and interpersonal skills Ability to work independently and as part of a team Strong customer service ethos Results driven Effectively manage time and prioritize tasks to meet deadlines and achieve team targets Uphold the highest standards of integrity and ethics in handling sensitive member information and making claims decisions