Claims Assessor – First Mutual Health

Job Description

Applications are invited from suitably qualified and experienced persons to fill the above vacancy that has arisen within First Mutual Health Proprietary Limited – Botswana.

Job Summary
Type: full-time
Location: Gaborone
Category: Insurance
Closing Date: 2026-08-28

Key Responsibilities
– Contributing to the continuous improvement of processes within the Claims department.
– Adjudicating claims for accuracy and appropriateness before payment.
– Processing preauthorisations at the request of members and service providers.
– Engaging health service providers where clarifications on claims or quotations are required, or around claiming procedures.
– Attending to email, telephone and in-person queries on claims and preauthorizations from members and service providers.
– Investigating the nature of queries and resolving or contributing to the resolution of the queries.
– Devising and implementing strategies to identify any fraud, waste and abuse on submitted claims before payment.
– Attending to ad hoc requests by service providers and members in a timely manner.

Requirements
– A diploma or degree in Nursing Science or a similar healthcare qualification is required.
– A qualification in healthcare forensics is an added advantage.
– Two years’ experience in a similar environment
– Excellent organizational skills
– Detail-oriented personality
– Strong communication skills

How to Apply
To apply, please visit: forms.cloud.microsoft.com