Quality Assurance Officer at Jubilee Insurance

Job Ref. No: JHIL082

Role Purpose

• Under general supervision, the role holder is responsible for performing intermediate and daily quality assurance reviews to ensure and report on the accuracy of claims processing end-to-end and other key business processes.

Main Responsibilities
Operational

• Periodically and methodically audit medical claim transactions, including high value claims.
• Determine error sources and give recommendations for resolving.
• Ensure pricing arrangements have been applied accurately.
• Analyze claims’ supporting documents to establish validity and liability.
• Monitor key interfaces and ensure that they adhere to the set claims-handling standards and escalate non- adherence to management.

 Corporate Governance

• Ensure compliance with company policies, procedures, and regulatory guidelines.
• Maintain confidentiality and handle sensitive information in accordance with privacy laws and regulations.
• Adhere to ethical standards and maintain professional conduct while dealing with confidential or sensitive matters.

 Culture

• Engaging in ongoing professional development activities to enhance knowledge and skills in quality assurance, regulatory compliance, and corporate governance.
• Foster effective working relationships with internal stakeholders.
• Foster a culture of accountability and responsibility within the quality assurance function.
• Serve as a role model for exceptional customer service and professionalism.
• Change Management: Assist in driving change initiatives within the quality assurance team and the broader organization. Help team members adapt to changes and foster a culture of agility and continuous improvement.

Key Competencies

• Detail-oriented with problem-solving abilities, structural and conceptual thinking.
• Ability to handle detailed tasks and work with varying types of data.
• Ability to maintain confidentiality.
• A team player willing to learn, apply and improve Quality Assurance best practices consistently.

 Qualifications

• Bachelor’s degree in any Healthcare related field.
• Proficiency in data analysis using MS Excel or other advanced tools is an added advantage.
• Professional qualification in Insurance (ACII, AIIK) is an added advantage.
• Knowledge of medical insurance claims processes and procedures.
• Knowledge and experience in clinical settings.
• Knowledge and experience in the insurance concepts & regulatory requirements.

Relevant Experience

• 3 years’ experience in customer service or quality assurance in the insurance industry