HEALTH CLAIMS DESKTOP REVIEW OFFICER 1 (SHORT TERM CONTRACT – ONE YEAR)

Job description

EMPLOYMENT OPPORTUNITY

ZSIC Life Plc, an equal opportunity employer, is a leading provider of long-term life assurance services and is wholly owned by the Industrial Development Corporation (IDC). With an established branch network across Zambia, the company offers flexible, reliable, and high-quality life assurance, pension, and fund management services.

An opportunity has arisen in the Insurance Business Department, and ZSIC Life Plc invites applications from suitably qualified, highly motivated, and self-driven Zambian nationals for the position below to be based in Lusaka:

HEALTH CLAIMS DESKTOP REVIEW OFFICER 1 (SHORT TERM CONTRACT – ONE YEAR)

PURPOSE OF ROLE

To conduct “desktop” reviews of historic health claims data to assess provider billing against pricing schedules, identify cost drivers, and detect potential fraudulent, wasteful, or abusive practices. The role protects the ZSIC Life Plc from financial leakage while ensuring members receive appropriate, value-based care. 

KEY PERFORMANCE AREAS (KPIs)

  KPI 1: Claims Data Analysis

• Extract and analyse historic claims data from the claims system for the past 36 months;

• Review claims against contracted pricing schedules, tariffs, and benefit limits;

• Identify outliers in billing patterns: high frequency, high cost, upcoding, unbundling.

   KPI 2: Fraud, Waste & Abuse Detection

• Flag potential duplicate billing, phantom members, services not rendered, billing for    non-covered services;

• Investigate anomalies in provider behaviour vs peer benchmarks;

• Document findings with supporting evidence for escalation.

  KPI 3: Pricing & Contract Compliance

• Validate that provider claims align with agreed fee-for-service schedules;

• Monitor for tariff inflation, split billing, and incorrect coding ICD-10 / CPT;

• Support contract negotiations with data-driven insights.

   KPI 4: Reporting & Recommendations

• Produce a compressive Desktop Review Report with findings, cost impact, and recommendations;

• Track provider recoveries and savings achieved;

• Present findings to Provider Relations, Legal, and Claims teams.

   KPI 5: Stakeholder Engagement

• Liaise with Provider Relations for provider queries and education on billing rules;

• Support audits and respond to regulatory requests for claims data.

PERSONAL ATTRIBUTES

• Organized

• Smart

• Problem Solving

• Integrity

• Attention to detail

• Innovative

• Agile

• Confidential

SKILLS REQUIRED

a)      Technical:

• Advanced Excel: pivots, VLOOKUP, data analysis

• Claims administration systems

• Knowledge of medical coding ICD-10, tariff structures

b)      Core:

•Analytical thinking + attention to detail

• Knowledge of health insurance benefits, provider contracts, and regulations

• High ethical standards and confidentiality

• Strong written communication for investigation reports

• Ability to work independently in a desktop/remote environment

MINIMUM QUALIFICATIONS AND EXPERIENCE

• Grade 12 Certificate (ZAQA certified)

• Diploma or Degree in Health Sciences, Nursing, Pharmacy and Health Information Management (ZAQA certified)

•  Minimum of 3 years’ relevant work experience in Health Insurance Claims, Provider Audit and Medical Review.

APPLICATION PROCEDURE

Interested candidates should send an application letter, Curriculum Vitae, and certified copies of academic qualifications by ZAQA to jobs@zsiclife.co.zm.

State the Job title in the Subject line.

Letters should be addressed to:

Chief People and Culture Officer

ZSIC Life Plc,

Insurance House, Stand No. 4432 Cairo Road,

Box 30507,

LUSAKA.

The closing date for submission of applications is 2^nd September 2026 by close of business.

ZSIC Life Plc is an equal opportunity employer.