Remote Medical Claims Reviewer (Part-Time/Full-Time)

About Company Radiant Yacu Ltd is a leading and innovative health insurance provider committed to ensuring accessible and comprehensive healthcare for individuals and families across Rwanda. With a strong focus on client well-being and exceptional service, we leverage technology and a dedicated team to manage health claims efficiently and transparently. Our mission is to empower healthier lives by making quality medical care affordable and understandable, contributing significantly to the nation's health sector. We foster a culture of integrity, collaboration, and continuous improvement, striving to be the trusted partner in our members' health journeys. Join a team dedicated to making a tangible difference in the health and well-being of Rwandans.

Job Description

Are you a detail-oriented professional with a passion for healthcare and a knack for precise claims processing? Radiant Yacu Ltd is seeking a dedicated Remote Medical Claims Reviewer to join our growing team. This is a unique opportunity to contribute to vital healthcare services from the comfort of your home, supporting our mission to provide accessible and efficient health insurance in Rwanda. We are open to both Full-Time and Part-Time engagements for this role, offering flexibility to suit your lifestyle while ensuring our members receive timely and accurate claim resolutions. As a Remote Medical Claims Reviewer, you will be at the forefront of evaluating and processing medical claims, ensuring compliance with policy guidelines, medical necessity criteria, and regulatory standards. Your keen eye for detail and commitment to fairness will directly impact our members' satisfaction and our operational efficiency. We are looking for an individual who is not only proficient in claims assessment but also possesses strong communication skills and an empathetic approach to support our diverse member base. This role requires self-discipline, excellent organizational skills, and the ability to work independently within a structured framework. If you are passionate about healthcare, meticulous in your work, and eager to contribute to a thriving organization, we encourage you to apply. Join us in making a tangible difference in the lives of Rwandans by ensuring fair and accurate access to healthcare benefits.

Key Responsibilities

• Review and process medical claims in accordance with established policies, procedures, and regulatory requirements.
• Verify the accuracy, completeness, and eligibility of submitted claims documentation.
• Utilize medical coding knowledge (e.g., ICD-10, CPT) to ensure proper claim adjudication.
• Communicate effectively with healthcare providers and members to resolve discrepancies and gather additional information.
• Maintain strict confidentiality and adhere to all data privacy regulations (e.g., GDPR, local Rwandan laws).
• Identify and report potential fraudulent claims or policy abuse to management.
• Participate in ongoing training and professional development to stay current with healthcare trends and policy changes.
• Contribute to process improvements to enhance claims processing efficiency and accuracy.

Required Skills

• Proven experience as a Medical Claims Reviewer or in a similar role within healthcare or insurance.
• Strong understanding of medical terminology, CPT, ICD-10 coding, and healthcare billing practices.
• Exceptional attention to detail and analytical problem-solving abilities.
• Excellent written and verbal communication skills in English and Kinyarwanda.
• Proficiency in using claims processing software and general office applications (Microsoft Office Suite).
• Ability to work independently, manage time effectively, and meet deadlines in a remote work environment.
• High level of integrity, ethical conduct, and commitment to patient confidentiality.

Preferred Qualifications

• Bachelor's degree in Nursing, Health Administration, Business Administration, or a related field.
• Certification in medical coding (e.g., CPC, CCS) or claims adjudication.
• Experience with Rwandan healthcare regulations and insurance frameworks.

Perks & Benefits

• Competitive salary and performance-based incentives.
• Flexible part-time or full-time remote work options.
• Comprehensive health insurance coverage for you and your dependents.
• Opportunities for professional development and continuous learning.
• Supportive and collaborative team culture in a growing organization.
• Contribution to meaningful work that positively impacts Rwandan communities.

How to Apply

Interested candidates are encouraged to apply by clicking the link below. Please ensure your CV and a cover letter outlining your experience and suitability for this remote role are attached. Apply tot his job Apply To this Job