Multiple Positions – NHIMA
NHIMA
NATIONAL HEALTH INSURANCE MANAGEMENT AUTHORITY
EMPLOYMENT OPPORTUNITIES
PART I: BACKGROUND
The National Health Insurance Management Authority (NHIMA) is a statutory body established under the National Health Insurance Act No.2 of 2018. NHIMA’S primary mandate is to provide for sound financing for the national health system to provide universal access to quality insured health services to all Zambians and Residents. As part of the operationalization of the scheme, the Authority now wishes to recruit the underlisted roles.
PART II: JOB LISTING DETAILS.
1. Senior Accountant Benefits and Claims x 1, Lusaka, Zambia
Job Purpose
Reporting to the Manager Finance, the Senior Accountant Benefit & Claims shall be an expert in finance, paying close attention to expenditure of the Authority with bias towards Claims to Accredited Health Care Providers (AHCPs) ensuring that payments are appropriately generated, duly authorised, and accurately recorded and well detailed for comprehension.
Key Responsibilities
The key functions of the role will include but not limited to;
Promptly processes Claims and Claim Advance Payments due to AHCPs.
Reconciliation of Claims payment runs every time payments are made to accredited health care providers.
Reconciles health care service providers statements.
Develops, maintains, and analyses trends of payments to Accredited Health Care Providers to aid management decision making.
Analyse trends, claims costs, financial commitments, and obligations, and to project future payments to Accredited Health Care providers.
Monitors and evaluates scheme benefits and claims in line with budgetary provisions.
Prepares, compiles and submits technical accounting reports in line with contractual agreements with accredited health care providers and key stakeholders.
Assists in preparation of Year End Statutory Financial Statements for the Authority.
Staff & Learning Environment
Ensure staff under your charge are appropriately inducted, motivated and trained.
Implement a performance management system for staff in the Unit under your charge
Perform other tasks as may be directed by the Director Finance & Investments and/or Manager Finance
Systems, Processes and Risk Management
Assists in closure of Internal & external audits of the Authority,
Assist in coordination with other departments during internal and external audits,
Establishes internal controls to enhance accountability and prudent utilization of resources,
Initiates claims payments in a timely manner due to accredited health care providers, and
Adheres to regulatory and organization wide policies and procedures to enhance the general control environment of the Authority.
Knowledge, Skills, Qualifications and Experience
Holder of a Bachelor’s Degree in Accounting or equivalent Professional qualification such as ACCA, CIMA or ZICA
Grade Twelve (12) School certificate or its equivalent with 5 credits or better which should include Mathematics and English Language,
Minimum of 5 years relevant work experience in insurance or financial institution, and
Certification in computer literacy.
Competencies required for this Role
Must be an effective communicator and should have high knowledge of finance,
Strong mathematical and analytical skills,
Must have good interpersonal skills and organisational skills,
Must be a critical thinker,
Must be skillful in Microsoft Word, PowerPoint, and Excel and proficient in Accounting applications (SAGE 300, Navision etc),
Must show practical understanding of a good control environment,
Proven ability to handle multiple projects simultaneously, and
Must have excellent time management skills and ability to prioritize.
2. Senior Data Protection Officer x 1, Lusaka, Zambia
Job Purpose
Reporting to the Audit & Risk Manager, the Senior Data Protection Officer (SDPO) will be responsible for ensuring that the Authority meets its data protection obligations across all its operations. The SDPO will monitor and report on compliance and data practices to ensure that the Authority adheres to applicable data protection regulations. The SDPO will standardise policies and procedures across the Authority, including acquisitions, to ensure consistent data protection practices. Additionally, the SDPO will be responsible for advising on privacy risks, staff training, data protection impact assessments, and conducting internal audits across the Authority.
Key Responsibilities
The primary responsibilities of the role will be:
Compliance Oversight:
Develop and implement data privacy policies and procedures aligned with data protection regulations.
Monitor data processing activities across the Authority to identify potential risks and non-compliance issues.
Conduct regular data protection audits and assessments to verify compliance.
Investigate data breaches and incidents, coordinating response and remediation efforts.
Risk Management:
Perform Data Protection Impact Assessments (DPIAs) on new projects or data processing activities to identify and mitigate risks.
Evaluate data protection controls and recommend improvements to data security practices.
Analyse data privacy risks and develop mitigation strategies.
Employee Training and Awareness:
Design and deliver comprehensive data privacy training programs for all levels of employees.
Educate staff on data handling procedures, data subject rights, and data protection regulations.
Data Subject Requests:
Manage data subject access requests, rectification requests, and deletion requests in accordance with data protection laws.
Investigate and respond to data subject complaints.
Liaison with Regulatory Bodies:
Serve as the primary contact point for data protection authorities, providing information and responding to inquiries regarding data processing activities.
Keep abreast of evolving data protection regulations and advise management on necessary updates.
Knowledge, Skills, Qualifications and Experience
Bachelor’s degree in Business Administration, Law, Accountancy or related Degree.
Grade 12 School Certificate or its equivalent with five (5) ‘O’ Levels (Credit or better).
At least 4 to 5 years’ working experience in Data Protection or regulatory environment.
Qualification in Data Protection will be an added advantage.
Competencies required for this Role
Deep understanding of data protection laws: Expertise in relevant regulations like GDPR, Data Protection Act No.3 of 2021 etc.
Legal knowledge: Familiarity with data privacy legal frameworks and case law.
Technical proficiency: Basic understanding of data processing systems, IT infrastructure, and security controls.
Communication skills: Ability to communicate complex data protection concepts clearly to both technical and non-technical audiences.
Analytical skills: Capability to assess data processing activities, identify risks, and develop effective mitigation strategies.
Leadership and stakeholder management: Ability to influence and collaborate with cr
oss-functional teams across the organization.
3. Provider Reconciliation Officer x 1, Lusaka, Zambia
Job Purpose
Reporting to the Senior Health Risk Officer, the main role of the jobholder is to manage Health Care Providers claims and Finance/payment reconciliations by ensuring timely claim payments and reconciliations and identifying and correcting any discrepancies. The role will also be responsible for receiving and admission of claims in the claims register and ensuring timely correspondence with Health Care Providers on any omissions that are picked before claims are admitted on the claims register.
Key Responsibilities
Principle Accountabilities:
Principle Accountabilities for this role include but are not limited to the following:
i. Claim settlements and reconciliations (70% weight)
To verify totals on the received invoices and inform Health Care Providers by e- mail/letter of any differences by matching statements from Health Care Providers with batches on the claims register and physical claims
Reconcile balances between Health Care Providers and NHIMA and maintain files for each Health Care Provider for returned bills to have quick and efficient access to HCP Queries
To reconcile all payments with Health Care Providers within 90 days of receiving settlement transfer advice.
Follow up reconciliation statements submitted on a month-by-month basis
Prepare updated reconciliation statements for HCP Accounts on a weekly basis and submit Weekly, monthly, quarterly and adhoc reports to Supervisor.
Preparation of Individual HCP Quarterly Reconciliation statements and submit to HCP after verification with Supervisor, every quarter and reconcile accounts within 15 days of submission to HCP.
Sign off accounts once reconciliation is agreed and completed and maintain report of
Health Care Providers’ Sign offs for due reference as required
ii. Health Care Provider Customer Care & Preliminary Claims Preassessment (30% weight)
Receive claims from Health Care Providers and conduct quality check/preliminary claims assessment for obvious omissions immediately on submission for physically delivered claims and within 5 days for couriered and SFTP uploaded claims
Maintain emerging issues tracker to be shared as part of weekly reports for due intervention
Ensure any picked submission omissions are communicated to Health Care Providers within 10 days from received date
Admit all qualifying claims in the claims register immediately on receipt
Maintain good business relationship with Health Care Providers and conduct Health Care
Provider sensitisation on NHIMA Benefits, Tariffs, and importance of properly filled in claim forms
Post adjudication and post payment, actively timely engage Health Care Providers on claims submission omissions, incomplete and rejected claims, to avoid unnecessary disputes and disruptions in service provision due to non-payment of such claims.
Maintain regular contact with Health Care Providers and any unpaid bills should be advised to the Health Care providers within 15 days after payment remittance notification by Finance.
Participate in any other claims process roles as demand arises and as guided by the Supervisor.
Conduct any other roles as assigned by the Supervisor.
Knowledge, Skills, Qualifications and Experience
Grade twelve (12) School certificate or its equivalent with 5 ‘O’ levels with credit or better including Mathematics and English Language
Must have a Degree in Healthcare Management or any related field
Certificate or Diploma in Health Insurance, Compensation fund or any social security is an added advantage
At least 1 year working experience in a similar role.
Competencies required for this Role
Extensive knowledge of the Insurance industry.
Overall understanding of Health Care provider operations and medicine and treatment procedures.
Financial acumen.
Attention to detail, strong analytical and decision-making skills.
Strong problem-solving and decision-making abilities, and ability to work under pressure
Good oral and written communication skills.
4. Accountant Expenditure x 1, Lusaka, Zambia
5. Assistant Accountant Expenditure x 1, Lusaka, Zambia
6. Assistant Provider Reconciliation Officer x 2, Lusaka, Zambia
PART III: APPLICATION INSTRUCTIONS
For full details of the positions and submission of applications, please
Visit the NHIMA website careers.nhima.co.zm‣ Click on the position you are applying for and attach the necessary documentation.
Only Shortlisted candidates will be contacted.
NHIMA IS AN EQUAL-OPPORTUNITY EMPLOYER, ALL QUALIFIED APPLICATIONS WILL RECEIVE EQUAL CONSIDERATION FOR EMPLOYMENT
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