International Medical Corps never asks job applicants for a fee, payment, or other monetary transaction. If you are asked for money in connection with this recruitment, please report to International Medical Corps at the website for reporting misconduct: www.InternationalMedicalCorps.ethicspoint.com. Please do not submit your CV or application to this website, it will not be considered for review. 

Job Title: Medical Claims Officer FSR # 484

Location: Amman Office

Job Summary

The role of the Officer Monitoring, Evaluation, Accountability, and Learning,(auditor) will implement the audit work plan and contribute to achieving and improving the quality of the program/project. The medical claims officer will provide support by collecting and managing the audit invoices and achieve highest target in quality and quantity.

To perform this job successfully, an individual must be able to perform each essential function with or without reasonable accommodation.

Main Tasks and Responsibilities 

IMC’s policies, guidelines, and procedures

• Actively promote Prevention of Sexual Exploitation and Abuse (PSEA) standards within IMC and amongst its beneficiaries.
• Contribute to the creation of a positive image and overall credibility of the organization, notably through the application of the Code of Conduct, ethics, values, and standpoint with regards to internal and external actors.
• Apply the basic monitoring, evaluation, accountability and learning concepts and the purpose of MEAL, with a specific focus on accountability to affected populations (AAP).
• Support the implementation of policies and procedures for monitoring, evaluation, and reporting in the country specific to AAP and CHS commitments.
• Project design and planning
• Participate in needs assessments by organizing the training for enumerators on assessment methodology, tools, respondent’s selection, and supervise field team to ensure field level data integrity.
• Ensure that MEAL activities are participatory and uphold accountable and useful MEAL systems.
• Support in developing results framework and log frame, including indicators, for simple projects.

Audit Department.

• Communicate with the hospital to prepare invoices.
• Registration of claims upon received.
•  Make sure that all claims’ documents and details are complete (original invoices, medical reports, diagnostic procedure results, copy of referral)
• Medical examination to ensure that the treatments and procedures match the diagnosis.
• Examine whether the incurred treatments and procedures are covered under the referral letter conditions,
•  Assure that treatments and procedures didn’t exceed the referral estimated cost.
•  Entering all claims details into the system.
•  Compare the approval given with the actual claim.
• Applying the agreed price list, package deal and discounts for each provider.
•  Correspondence with all Providers.
•  Monthly Reconciliations with all medical providers.
• Entered the audited claims on the claims system.  
•  Prepare monthly detailed reports for each medical provider.
• Convert entered and audited claims to financial department and coordinate with finance for payments.
• Prepare the required statistical reports.

The duties and responsibilities listed are representative of the nature and level of work assigned and are not necessarily all inclusive. 

Minimum Requirements:

• Typically, bachelor’s degree in pharmacy nursing, with experience in auditing.
• A strong background in auditing, in and out -patient
• Typically, 2+ years of experience in medical insurance company.
• Knowledge of data pitfalls, issues, and strategies for assessing the quality of collected data.
• Knowledge of commonly used probability and purposive sampling techniques and different methods of qualitative and quantitative data collection and analysis.
• Knowledge of descriptive univariate and bivariate data analysis using Excel Pivot tables or other advanced analysis software.
• Knowledge of indicators and their measurement in the different sectors of relevance.
• Understand the concept of participatory monitoring, evaluation, accountability, learning, and needs assessment.
• Excellent proficiency in Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint.
• Strong training facilitator/presentation skills.
• Effective communication and interpersonal skills.
• Have analytical, conceptual, and strategic thinking skills.
• Manage performance by setting clear goals.

Child Safeguarding

International Medical Corps is committed to child safeguarding and expects all employees to strictly adhere to the values and principles of the International Medical Corps Child Safeguarding Policy.

Code of Conduct

It is our shared responsibility and obligation to prevent matters involving Sexual Exploitation & Abuse, trafficking in Persons, Child Safeguarding and any suggested violation to our Code of Conduct, which may involve Conflicts of Interest, Fraud, Corruption or Harassment.  If you see, hear or are made aware of any suggested activities then you have an obligation to report.

Compliance & Ethics

Promotes and encourages a culture of compliance and ethics throughout International Medical Corps. As applicable to the position, maintains a clear understanding of International Medical Corps’ and donor compliance and ethics standards and adheres to those standards.  Conducts work with the highest level of integrity. Communicates these values to staff and to partners and requires them to adhere to these values.

Equal Opportunities

International Medical Corps is proud to provide equal employment opportunities to all employees and qualified applicants without regard to race, color, religion, sex, sexual orientation, national or ethnic origin, age, disability or status as a veteran.

This job description is subject to periodic review and adjustment in order to achieve International Medical Corps goals in Jordan, and any changes to the job description will be discussed and agreed

“I hereby certify that all the information provided through the application and CV are accurate and the supportive documents are available upon request, any false information provided will cause cancelation of the application and applicant will be subject to legal action”.

Our screening process will be on a rolling basis, once a candidate is selected the announcement will be closed.