- Effective knowledge of HMO marketing/business development
- Prompt submission of monthly capitation
- Appropriate adjudication, negotiation of claims
- Timely treatment of pre-authorization requests and codes
- Sufficient and effective deployment of monitoring/quality assurance tools
- Effective provider visitation and proper reporting of visits and Quality Assurance tools utilized in weekly report.
- Effective use of computer to analyze report and submit reports.
Personal Characteristics/Skills desired
- Strong knowledge of the HMO industry
- Must have excellent computer skills (MS Office) and the ability to learn new systems/programs quickly!
- Strong analytical, investigative and organizational skills
- Excellent verbal and written communication skills
- Strong attention to detail
- Must be able to work sometimes long hours during the busy periods
- Ability to prioritize, handle pressure & responsibility, and work within deadlines strongly emphasized
- Able to write and submit report as at when due