Health Risk Officer Onelife Assurance

Onelife is licensed by the Pensions and Insurance Authority (PIA) specializing mainly in the corporate health sector but keen to expand into more individual business both in the health and life insurance sectors, requires, a versatile, dynamic, self-motivated, highly credible, and suitably qualified individual to fill the vacant position of Health Risk Officer (1) based in Kitwe.

Job Description Summary

• Assessment and verification of all claims presented to ensure that they fall with the scope of respective insurance policy cover and that policy conditions have been met.
• Assist in managing shortfalls and ensure HCP’s are complaint with scheme rules
• Attend to referrals and evacuations and escalate accordingly.
• Maintain sound business relations with HCP’s and manage HCP network.
• Attend to HCP queries in timely fashion and respond to hot line enquiries.
• Process pre-authorizations.
• Continuously monitor quality checks as it relates to medicines dispensed and quantities.
• Prepare periodical reports as requested from time to time.
• Negotiate pricing of with HCP’s for various services.
• Undertake health risk inspections and ensure that HCP’s comply with approved standards.
• Share risk improvement measures with the underwriting department for follow up with client.
• Claims quality assurance to ensure error rate is accepted standard.
• Act as counsellor and advisor to patients/members.
• Build and maintain relationships with clients and stakeholders.
• Deliver client-centric processes and solutions.
• Attend to walk in clients and provide the necessary assistance.
• Develop and maintain productive and collaborative working relationships with peers and stakeholders.
• Positively influence and participate in change initiatives.
• Identify solutions to enhance cost effectiveness and increase operational efficiency.

Qualification and Experience

• Must have at least a first degree from a recognised university.
• Degree in Insurance and or/Health Sciences is preferred.
• Three (3) years’ experience is required.
• A minimum of one years’ experience in a similar role within the industry.
• A minimum of one years’ experience working in or in collaboration with a health facility is an added advantage.