Job Title: Claims Vetting Officer (Midwives)
Organisation: PricewaterhouseCoopers (PwC)
Duty Station: Kampala, Uganda
Reference Number: 129-UGA00020
PricewaterhouseCoopers (PwC) supports organisations and individuals create the value they’re looking for. We’re a network of firms in 157 countries with more than 208,000 people who are committed to delivering quality in assurance, tax and advisory services. Our purpose is to build trust in society and solve important problems. Our in-depth knowledge and understanding of operating environments in Uganda and the region enables us to put ourselves in our clients’ shoes and offer truly tailored Tax, Assurance and Advisory solutions to unique business challenges.
About Voucher Plus Project:
Abt Associates has sub-contracted PwC as the Voucher Management Agent (VMA) that will manage the entire cycle of the voucher program from printing and distribution of vouchers to partners, contracting of Voucher Service Providers (VSPs), redemption of vouchers and payment of authenticated claims to VSPs. Uganda Voucher Plus Activity is a 5 year maternal health voucher program. The program will distribute approximately 385,000 vouchers to poor pregnant mothers in Eastern and Northern Uganda.
Job Summary: The Claims Vetting Officer (Midwives) will be tasked with the verification of y all voucher claims entered into the claims processing system (VMIS). All decisions taken by Claims Vetting Officer (or Vetter) must be medically informed and clearly documented in the system. The Claims Vetting Officer (Midwives) is expected to investigate all quarantined claims directly with the Voucher Service Provider (VSP) and gather sufficient evidence to subsequently approve or reject the claim. Performance will be measured by the number of claims vetted correctly and the integrity of data input in the VMIS to support or reject claims. The Claims Vetting Officer (Midwives) is expected to work in close collaboration with the entire Voucher Management Agent team and VSPs to facilitate an effective and efficient payment process.
Key Duties and Responsibilities:
· The incumbent will also carry out the technical review of all claims entered into in the VMIS by data entrants and either approve, quarantine or reject the claims. Evaluate each claim from a logical, medical and technical perspective
· Match the cost of claims against services provided
· Identify claims with anomalies for quarantine and/or reject incomplete claims with supporting documentation
· Work closely with VSPs to further investigate claims anomalies from a medical and technical perspective.
· Make calls or conduct visits to VSPs with quarantined claims to collect any further evidence supporting their claims
· Advise VSPs on improvements required when submitting subsequent claims
· Manage and handle all data with confidentiality and ensure all data protection mechanism are strictly adhered to
· Compare new claims against historical claims from the respective VSPs and note trend of repeated incidences of claim issues. Report recurrent issues to the supervisor with supporting evidence
· The incumbent will also recommend areas for follow-up during field spot checks/ verification and actively participate in spot reviews as will be guided from time to time by the Claims and Settlements Manager
· Perform any other duties as will be assigned by the Claims and Settlements Manager from time to time.
Qualifications, Skills and Experience:
· The ideal candidate for the Claims Vetting Officer (Midwives) career opportunity must hold a Diploma in nursing/midwifery
· Advanced qualification will be an added advantage
· A minimum of three years of medical experience in midwifery or related field
· Prior experience in the use of computer applications
· Proven ability to maintain high levels of confidentiality & integrity
· Keen attention to detail
· Ability to communicate effectively at all levels
How to Apply:
If you are confident that you fit the person and job profile and you are keen on growing your career with one of the leading Consultancy firms in the Country, please visit our Careers website.
Deadline: 8th September 2016
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