Care Analyst

This vacancy presents a chance to join a leading organization. Position Overview: The role holder will be responsible for ensuring that Heritage customers receive affordable, accessible, cost effective and high-quality healthcare services. Key Responsibilities: - Membership benefit utilization management - Verification and assessment of pre-authorization requests and claims - Hospitalizations management and cost optimization - Review and pre-screening of received claims - Customer service-handling calls, addressing client queries on all touch points - Maintain proper departmental standards - Process/adjudicate claims - Case management through hospital visits Required Qualifications: - Bachelor’s degree in Nursing/Diploma in Nursing or Clinical Medicine Experience: - At least 1 year technical knowledge in medical insurance or hospital setting. Competencies - Understanding of health insurance operations and concepts - Knowledge of medical claims processes and procedures - Stakeholder management - Customer service