Risk Assessor

Reporting to the****Senior Risk Health and Wellness Officer

The main responsibilities of the job are:

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• 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.

Qualifications:

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• 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.

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Ideal Candidate must:

• 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.