HEALTH CLAIMS DESKTOP REVIEW OFFICER X1

Health Claims Desktop Review Officer Jobs in Lusaka ZSIC Life Plc, a respected leader in long-term life assurance services in Zambia, is currently seeking a highly motivated and detail-oriented professional to join their Insurance Business Department in Lusaka.

This opportunity for a Health Claims Desktop Review Officer is ideal for individuals passionate about ensuring financial integrity and quality care within the health insurance sector. About ZSIC Life Plc As a wholly owned subsidiary of the Industrial Development Corporation (IDC), ZSIC Life Plc operates an extensive branch network throughout Zambia.

The company is committed to providing flexible, reliable, and high-quality life assurance, pension, and fund management services while fostering an inclusive workplace as an equal opportunity employer.

Position:

• Health Claims Desktop Review Officer (Short-Term Contract – One Year) This full-time role is based in Lusaka and focuses on performing comprehensive desktop reviews of historic health claims data.

The successful candidate will play a critical role in protecting the company from financial leakage by assessing provider billing accuracy, identifying cost drivers, and detecting potential fraudulent or abusive practices.

Key Responsibilities in Health Claims Desktop Review Officer Jobs in Lusaka Claims Data Analysis:

Extract and analyze health claims data from the past 36 months, review claims against pricing schedules, tariffs, and benefit limits, and identify unusual billing patterns such as high frequency, upcoding, or unbundling.

Fraud, Waste & Abuse Detection:

• Detect duplicate billing, phantom members, non-rendered services, and billing for non-covered services; investigate provider anomalies compared to peer benchmarks; document findings for escalation.

Pricing & Contract Compliance:

• Ensure provider claims comply with fee-for-service schedules, monitor tariff inflation and coding accuracy (ICD-10/CPT), and support contract negotiations with data insights.

Reporting & Recommendations:

• Prepare detailed Desktop Review Reports outlining findings, financial impact, and recommendations; track recoveries and savings; present results to relevant teams.

Stakeholder Engagement:

• Collaborate with Provider Relations to address queries and educate on billing rules; assist with audits and regulatory requests for claims data.
• Required Skills and Personal Attributes Candidates must demonstrate strong analytical skills, attention to detail, and high ethical standards.
• Essential technical skills include advanced proficiency in Excel (pivot tables, VLOOKUP), familiarity with claims administration systems, and knowledge of medical coding and tariff structures.
• Core competencies involve excellent written communication, independent working capability, and confidentiality.

Organized, innovative, and agile problem solver Integrity and confidentiality in handling sensitive information Experience with health insurance benefits, provider contracts, and regulatory frameworks Qualifications and Experience Grade 12 Certificate (ZAQA certified) Diploma or Degree in Health Sciences, Nursing, Pharmacy, or Health Information Management (ZAQA certified) Minimum of 3 years’ relevant experience in health insurance claims, provider audit, or medical review Application Process Interested candidates should submit a cover letter, Curriculum Vitae, and certified copies of academic qualifications by ZAQA to Apply Now.

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Applications must be addressed to:

• Chief People and Culture Officer ZSIC Life Plc Insurance House, Stand No.
• 4432 Cairo Road Box 30507, Lusaka Applications close on 2nd September 2026 by close of business.
• ZSIC Life Plc is proud to be an equal opportunity employer and encourages all suitably qualified Zambian nationals to apply.