Description

Are you ready to take on a vital role in enhancing healthcare standards in Rwanda? The Rwanda Social Security Board (RSSB)

is seeking a proactive and detail-oriented Senior Officer, Counter Verification, to join our team. If you are passionate about upholding standards and ensuring quality, this position is for you!;The Senior Officer, Counter Verification at the Rwanda Social Security Board (RSSB) plays a critical role in ensuring the accuracy and integrity of social security data and claims. This position involves conducting comprehensive reviews of submitted claims, ensuring compliance with established guidelines and regulations.

About RSSB

The Rwanda Social Security Board (RSSB)

has the mandate to manage and promote social security in Rwanda. RSSB’s vision is to provide a comprehensive social security system that caters to the diverse social security needs of the population, RSSB plays an important role in realising Vision 2050 and the National Strategy for Transformation (NST1). RSSB manages six social security schemes, namely: Pension, Occupational Hazards, Medical scheme, CBHI, Maternity Leave Benefits and EjoHeza (Long-term Term Saving Scheme).;As a leading player in the financial sector, RSSB serves as the largest institutional investor in Rwanda. With assets under management amounting to 2.06 trillion Rwf , which is equivalent to over 15% of the country’s GDP, RSSB invests in key sectors of the economy and plays a crucial role in growing the country’s financial sector. With approximately 12 million members in the above six schemes, encompassing over 90% of Rwanda’s population, RSSB is at the forefront of securing the health and financial well-being of Rwandans.;To achieve its important mandate, RSSB is embarking on a transformative journey, aiming to become a modern, data-driven, and high-performing institution. As part of this ambitious initiative, we are seeking highly motivated individuals who are results-oriented and uphold the highest standards of professionalism and integrity. By joining RSSB, you will have the opportunity to actively contribute to the advancement of social security and overall transformation of Rwanda.

Key Duties and Responsibilities

Key Duties and Responsibilities

• Develop and refine counter-verification strategies for medical invoices to ensure accuracy, completeness, and compliance with Medical Insurance Scheme policies, tariffs, and regulatory standards.
• Conduct detailed counter-verification and audits of medical invoices submitted by contracted health service providers to identify discrepancies, inappropriate billing, or non-compliance with scheme guidelines.
• Analyse verification results to identify patterns, trends, and systemic issues in provider billing practices, and provide recommendations for corrective actions and process improvements.
• Prepare comprehensive reports summarising counter-verification findings, identified discrepancies, financial implications, and recommended actions for management review.
• Collaborate with claims management, medical verification, compliance, and provider management teams to ensure alignment of counter-verification activities with overall operational objectives and scheme policies.
• Support the development and delivery of training and guidance to verification teams on medical invoice review procedures, billing standards, and counter-verification methodologies.
• Stay updated on health insurance regulations, provider payment mechanisms, tariffs, and clinical billing practices to ensure counter-verification activities remain compliant with applicable standards.
• Establish and maintain quality control mechanisms to regularly assess and improve the effectiveness and consistency of medical invoice verification processes.
• Provide technical support to internal teams regarding counter-verification requirements, medical billing practices, and interpretation of scheme guidelines.
• Track and report key performance indicators (KPIs) related to invoice verification and counter-verification activities to evaluate operational efficiency and performance.
• Apply analytical techniques to detect potential fraud, abuse, or irregular billing patterns in medical invoices and recommend preventive and corrective measures.

Qualifications and Experience

Qualifications and Experience

• Bachelor’s Degree in Nursing, Allied Health Sciences, Public Health, Health administration or a related field, with at least 3 years of relevant experience in data verification, auditing or a related field
• Strong analytical skills and proficiency in data analysis tools (Excel, SQL, or similar) are highly desirable.
• Proficiency in analysing complex data sets
• Strong understanding of statistical methods for data integrity assessment
• Experience with Medical Invoice verification tools and software applications
• Regulatory Compliance Expertise for Health Insurance regulations and best practices.