Medical Claims Examiner or Claims Officer Training and Development Needs

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Prepared By: Solomon Sawerh PetteyOrganisation: Osu Klottey NHIS Location: Osu, Accra - Ghana

Medical Claims Examiner orClaims Officer| training & development| | | |

INTRODUCTION
Significant achievements have been made at arresting potential claim related challenges which threatened NHIS sustainability, but the claims still continue coming in fast with increased work load. The uses of technology and claim officers to effectively manage claims also continue to advance with meaningful results. This document therefore aims to use a scientific management approach to determine the training and development needs of claims officers, which can further enhance the effective and efficient management of claims.

Case in Point
Claims officers need to have certain knowledge, skills and abilities to examine medical claims effectively. The question is: what is the current capacity gap of knowledge, skills and abilities? The work of medical claim examination and approval are critical and complex and this lends support to the question above. The research aims to determine the training and development needs of claims officers by examining levels of education, professional background and prior knowledge of claims vetting and ways to determine the impact of training. Focus will be on the claim officers’ perspective of needs, best approach to close capacity gaps, and better enhancement of NHIA activities towards the improving upon the performance of claim officers.

About 70% of NHIS claims have been projected to be processed electronically, but leveraging technology in terms of claims management will not adequately address the capacity deficit, unless the manpower is well equipped to contribute meaningfully towards the rrealization of the company’s strategic goals.

Approach
Benchmarks
Challenge of expenditure
Traditional methods versus JUST-IN-TIME training and development for practical knowledge Continuum of learning/E-learning
Tailored Programs /...
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