Senior Medical Claims Officernew

CHILD SAFEGUARDING: (select only one)

Level 2: either the post holder will have access to personal data about children and/or young people as part of their work; or the post holder will be working in a ‘regulated’ position (accountant, barrister, solicitor, legal executive); therefore, a police check will be required (at ‘standard’ level in the UK or equivalent in other countries).

ROLE PURPOSE:

The Senior Medical Claims Officer is leading the claims team for controlling and monitoring project total medical expenditure including verifying and checking invoices and claims from providers, suppliers, vendors, and subcontractors to ensure that all project expenditures are captured and properly recorded

SCOPE OF ROLE:

Reports to: Senior Program Manager

Staff reporting to this post: 3 Medical claims Coordinators, + 1 admin

Role Dimensions: Close coordination with the Health Team, Finance Unit, and contracted health care providers.

KEY AREAS OF ACCOUNTABILITY:

· Leads the medical claim structure that will be autonomous from the medical team responsible for service delivery and case management.

· Manage medical claims reviewing process and provide reports related to cost control and planning.

· Manage and supervise the team of the medical claims coordinators for their main tasks of reviewing the medical claims submitted by the hospitals.

· Approve the medical reports, requirements, and documents received from health providers

· Review price lists and create comparisons among providers during the contracting phase

· Review and Sign off the final report for all claims with all comments and deductions

· Lead on setting corrective actions for the medical documentation required for the claims settlement with both the medical team and the hospitals.

· Leads the coordination with the finance team on the medical claims review since receiving the claims, its review, communicating deductions with the hospitals, payment approval and finally processing the payment.

· Lead on monitoring the status of all referrals, commitments, and claims up to the closure of the project

· Ensure the compliance of the medical claims with the Egyptian law and SCI policies, and also donor’s compliance.

· Work closely with the health program manager on preparing monthly spending and forecasted reports.

· Lead on the communication channels with health service providers in regards to the claims and deduction

· Provide cost-controlling support for all project activities which includes forecasting and variation reporting

· Review and sign off all medical cash payment for beneficiaries

· Lead on improving medical claims reports and documentations

· Provide technical support and guide the health service providers to increase accuracy in medical reports by health providers

· Carrying out tasks as requested by line managers as needed. • Participating in medical audits to enhance the medical claims documentation. • Ensuring the timeliness and completeness of the claims reporting process.

BEHAVIOURS (Values in Practice)

Accountability:

· holds self-accountable for making decisions, managing resources efficiently, achieving and role modelling Save the Children values

· holds the team and partners accountable to deliver on their responsibilities - giving them the freedom to deliver in the best way they see fit, providing the necessary development to improve performance and applying appropriate consequences when results are not achieved.

Ambition:

· sets ambitious and challenging goals for themselves and their team, takes responsibility for their own personal development and encourages their team to do the same

· widely shares their personal vision for Save the Children, engages and motivates others

· future orientated, thinks strategically and on a global scale.

Collaboration:

· builds and maintains effective relationships, with their team, colleagues, Members and external partners and supporters

· values diversity, sees it as a source of competitive strength

· approachable, good listener, easy to talk to.

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· Creativity:

· develops and encourages new and innovative solutions

· willing to take disciplined risks.

Integrity:

· honest, encourages openness and transparency; demonstrates highest levels of integrity

QUALIFICATIONS

· Bachelor of medicine is required

· Certificate in auditing, cost control is highly desirable

EXPERIENCE AND SKILLS

· Bachelor’s degree in medicine and surgery BSC is must

· 5-7 years’ experience in medical claims auditing, project cost planning and reporting

· Experience in healthcare setting is highly desirable

· High computer skills on MS office programs especially MS Excel

· Demonstrate strong interpersonal, communication and presentation skills

· Strong analytical and problem-solving skills and meticulous

· Possess good project background and technical writing ability and skills.

· Mature, proactive, resourceful and hands-on with good initiative.

· Good command in English, both verbal and written, required

Additional job responsibilities

The duties and responsibilities as set out above are not exhaustive and the role holder may be required to carry out additional duties within reasonableness of their level of skills and experience.

Equal Opportunities

The role holder is required to carry out the duties in accordance with the SCI Equal Opportunities and Diversity policies and procedures.

Child Safeguarding:

We need to keep children safe so our selection process, which includes rigorous background checks, reflects our commitment to the protection of children from abuse.

Safeguarding our Staff:

The post holder is required to carry out the duties in accordance with the SCI anti-harassment policy

Health and Safety

The role holder is required to carry out the duties in accordance with SCI Health and Safety policies and procedures.