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Claims Vetting Officer (Midwives) Careers – PricewaterhouseCoopers (PwC)
Job Title: Claims Vetting Officer (Midwife)
Organisation:
PricewaterhouseCoopers (PwC)
PricewaterhouseCoopers (PwC)
Duty Station: Kampala,
Uganda
Uganda
Reference Number:
129-UGA00026
129-UGA00026
About PwC:
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.
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.
(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 (Midwife) will verify 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. A Vetter 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. A Vetter is expected to
work in close collaboration with the entire Voucher Management Agent team and
VSPs to facilitate an effective and efficient payment process.
Officer (Midwife) will verify 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. A Vetter 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. A Vetter 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:
Responsibilities:
The officer will technically review all claims entered into in the VMIS
by data entrants and either approve, quarantine or reject the claims.
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.
medical and technical perspective.
- Make calls or conduct visits to VSPs with quarantined
claims to collect any further evidence supporting their claims - Guide the 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 - 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:
Experience:
- The ideal candidate should preferably 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 - Previous exposure and 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.
are keen on growing your career with one of the leading Consultancy firms in
the Country, please visit our Careers website.
Deadline: 19th March
2017
2017
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