Medical Quality Assurance Officer job at Jubilee Life Insurance

Job Summary

Jubilee Life Insurance Uganda is seeking a detail-oriented and analytical Medical Quality Assurance Officer to support the delivery of high-quality healthcare outcomes through effective medical claims review and quality assurance processes. The successful candidate will be responsible for ensuring accuracy, compliance, and consistency in medical claims processing while maintaining high standards of service delivery and healthcare quality.

Key Responsibilities

• Review and assess medical claims to ensure accuracy, completeness, and compliance with company policies.
• Conduct quality assurance audits on medical claims and healthcare service processes.
• Monitor claims processing standards and recommend improvements to enhance efficiency and quality.
• Identify trends, discrepancies, and potential risks in medical claims.
• Ensure adherence to medical insurance policies, regulatory requirements, and internal quality standards.
• Collaborate with healthcare providers, internal departments, and stakeholders to resolve claims-related issues.
• Investigate claim irregularities and escalate suspicious or fraudulent claims where necessary.
• Prepare quality assurance reports and performance analysis for management.
• Support the development and implementation of quality improvement initiatives.
• Maintain accurate documentation and records of quality assurance activities.
• Participate in continuous process improvement and compliance reviews.
• Perform any other duties assigned by management.

Qualifications

• Bachelor's Degree in Medicine, Nursing, Pharmacy, Health Sciences, Medical Laboratory Science, Public Health, Health Information Management, or another related healthcare field.

Experience

• Experience in medical claims processing, quality assurance, health insurance, healthcare administration, or a related field is an added advantage.
• Knowledge of health insurance operations and medical claims management is desirable.

Skills and Competencies

• Strong knowledge of medical terminology and healthcare practices.
• Understanding of medical insurance claims processes.
• Excellent analytical and problem-solving skills.
• High level of accuracy and attention to detail.
• Knowledge of quality assurance principles Strong report writing and documentation skills.
• Good communication and interpersonal skills.
• Ability to interpret medical records and healthcare documentation.
• Knowledge of quality assurance principles and compliance standards.
• Proficiency in Microsoft Office applications.
• Ability to work independently and as part of a multidisciplinary team.
• Strong organizational and time management skills.
• High ethical standards and integrity.

Key Competencies

• Attention to detail.
• Critical thinking.
• Decision-making.
• Customer service orientation.
• Confidentiality.
• Accountability.
• Teamwork.
• Professionalism.
• Continuous learning.

What Jubilee Offers

• Opportunity to contribute to quality healthcare outcomes.
• Professional growth and career development.
• Collaborative and professional working environment.
• Exposure to medical insurance and quality assurance best practices.

• Review and assess medical claims to ensure accuracy, completeness, and compliance with company policies.
• Conduct quality assurance audits on medical claims and healthcare service processes.
• Monitor claims processing standards and recommend improvements to enhance efficiency and quality.
• Identify trends, discrepancies, and potential risks in medical claims.
• Ensure adherence to medical insurance policies, regulatory requirements, and internal quality standards.
• Collaborate with healthcare providers, internal departments, and stakeholders to resolve claims-related issues.
• Investigate claim irregularities and escalate suspicious or fraudulent claims where necessary.
• Prepare quality assurance reports and performance analysis for management.
• Support the development and implementation of quality improvement initiatives.
• Maintain accurate documentation and records of quality assurance activities.
• Participate in continuous process improvement and compliance reviews.
• Perform any other duties assigned by management.

• Strong knowledge of medical terminology and healthcare practices.
• Understanding of medical insurance claims processes.
• Excellent analytical and problem-solving skills.
• High level of accuracy and attention to detail.
• Knowledge of quality assurance principles Strong report writing and documentation skills.
• Good communication and interpersonal skills.
• Ability to interpret medical records and healthcare documentation.
• Knowledge of quality assurance principles and compliance standards.
• Proficiency in Microsoft Office applications.
• Ability to work independently and as part of a multidisciplinary team.
• Strong organizational and time management skills.
• High ethical standards and integrity.

• Bachelor's Degree in Medicine, Nursing, Pharmacy, Health Sciences, Medical Laboratory Science, Public Health, Health Information Management, or another related healthcare field.