Quality Assurance Officer- (French Speaker)

NEXtCARE -
New Cairo, CairoPosted 1 year ago

47Applicants for2 open positions

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To review and audit our closed claims, with the status processed and settled.
To identify the areas, leakages and employees, which require improvement, additional control(s) and/or additional training in order to assist us in:
Control and detect claims leakage
Leakage detection, identification and analysis
Highlighting recoveries
Providing root case analysis and recommending improvement
Fraud, Abuse, Misuse and error detection.
Process efficacy and reliability.
Standarization of monitoring controls.

Evaluates medical claims from technical and medical perspectives as per policy terms and conditions.
Checks particular treatment plan that is necessary for the patient.
Refers for a second opinion for cases where there is doubt in the treatment plan.
Maintains daily productivity targets and service levels.
Manages routine daily claims administration work.
Coordinates workflow & meets deadlines.

Bachelor degree in Pharmacy/ Medicine and Surgery
French speaker is a must
Minimum 2 years’ experience from the market in a relevant role. (training facilitation experience – Instructor-led Training (ILT) and Virtual instructor-led Training (VILT) Operations / Process Training AND Corporate Training)
Flexible to accommodate changes/addition to duties, make efficient use of resources, and availability as per company requirements.
Excellent communication skills in English; Arabic-speaking highly preferred
Flexible to accommodate changes/addition to duties, make efficient use of resources, and availability as per company requirements.
Ability to work well as part of a team- to exhibit objectivity and be open-minded towards the ideas and views of others, give as well as welcome feedback, contribute to building team spirit, aid others to succeed.
Fluency in Microsoft Office applications (including Word, Access, PowerPoint, Excel), outlook and general internet and research skills.