Kayula Chipalo

• Reconciliation of Health Care Provider accounts • Holding constant meetings with each Health Care Provider on issues relating to contractual obligations between Prudential and the Providers. • Investigating any deviations in claims patterns and reporting such deviations to Health Care Providers Liaison Manager before following up on the same. • Expert evaluation, review and analysis of claims patterns and claims data on monthly basis and documenting recommendations to implement risk mitigation strategies • Research and analysis skills • Reconciliation of Health Care Provider accounts in collaboration with the reconciliation analysts • Ensuring that all rejected bills are submitted in real time to the Health Care Providers • Check that the balances in Smart and Arima always agree. • Ensuring that training/awareness programs are conducted, and necessary Health Care Provider information (Q&A or HCP guide) is disseminated to all the providers. • Strong commercial acumen and operational experience • Call center project management • Ability to work with limited supervision and make judgement calls

• Ensuring all Health Care Providers are well informed about claim procedures, policy benefits and exclusions • Verification and pre-authorization of in-patient cases. • Reconciliation of Health Care Provider accounts • Managing and follow up of suspended claims from providers • Provision of guidance to the reconciliations team in ensuring all accounts are fully reconciled while following up and managing returns from each provider. • Strong execution skills to achieve the targets of Prudential Zambia business • Research and analysis skills • Excellent Communication and reading comprehension • Holding constant meetings with each provider on issues relating to contractual obligations between PLAL and the providers. • Providing support and advice for members being referred within the HCP panel. • Ability to understand broad business issues. • Ability to think clearly and assess matters quickly and to solve problems on short notice • Ability to make/take calculated decisions and to think forward and act accordingly.

• Having knowledge and understanding of computer and the current insurance system in use • To verify totals on the received invoices and inform Health Care Providers by mail of any differences by matching statements from Health Care Providers with batches in PMI System. • Reconcile balances between Health Care Providers and Prudential Life Assurance • Prepare Weekly /Monthly Reconciliation Reports to Supervisor • To reconcile all payments with health care providers within 60 days of receiving settlement cheque/transfer advice; health care providers are required to re-submit suspended claims requiring