Exciting Career Opportunity at the Rwanda Social Security Board (RSSB) - Manager, Medical Audit

Are you ready to embark on a transformational journey? We are seeking a dynamic and experienced individual to join us as the Manager, Medical Audit. If you thrive in dynamic environments and are committed to innovation and transformation, this is the opportunity for you!

In this role, you will play a crucial part in periodic medical audits to detect non-compliant and fraudulent medical practices. You will also engage with medical service providers, report on audit findings, make recommendations to RSSB Senior Management, and monitor implementation of recommendations. Your efforts will contribute to the efficiency of RSSB-managed medical insurance schemes and to the continued growth and success of RSSB.

As the Manager, Medical Audit, you will be the specialist and lead a team that conducts medical audits at RSSB in collaboration with Medical insurance schemes. If you have what it takes to lead medical audits and to implement the regulatory standards, we encourage you to apply.

The Manager, Medical Audit will be responsible for overseeing medical auditing and quality assurance processes to ensure the accuracy, compliance, integrity and quality of medical claims and services provided to RSSB beneficiaries

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 realizing 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

• Lead and manage a team of medical auditors responsible for reviewing and analyzing medical claims, provider billing practices, and healthcare service documentation.

• Develop audit protocols, methodologies, and performance metrics to assess the accuracy and completeness of claims submitted and information in the medical records.

• Conduct regular audits to detect non-compliance and fraudulent practice, , and discrepancies in coding or documentation.

• Ensure compliance with regulatory requirements, healthcare industry standards, and internal policies related to medical and coding practices.

• Implement and enforce audit policies, procedures, and controls to maintain integrity and accuracy in claims processing.

• Collaborate with relevant medical departments, legal and compliance teams to address audit findings and implement corrective actions as necessary.

• Analyze audit results and trends to identify systemic issues, anomalies, or areas for improvement in claims processing and provider practices.

• Prepare comprehensive audit reports, findings, and recommendations for senior management and regulatory authorities.

• Develop and deliver training programs on audit protocols, compliance requirements, and best practices for medical auditors and healthcare providers.

• Provide guidance and support to internal stakeholders on coding guidelines, documentation requirements, and audit response strategies.

• Foster a culture of awareness and accountability in claims management and compliance with regulatory standards.

• Collaborate with internal departments, including claims processing, legal, and medical advisory teams, to ensure coordinated efforts in audit response and resolution.

• Build and maintain effective relationships with external stakeholders, including healthcare providers, insurers, and regulatory agencies.

• Mentor and manage medical audit officers under his supervision.

Key Qualifications and Experience

The successful candidate must have at least:

• Master’s Degree in Medicine (MMED), or other clinical education and public health/Global health, Health Economics, Health Financing or any other relevant field preferably with at least 2 years’ experience.

OR

• Bachelor’s Degree of Medicine, Bachelor of surgery or other clinical education and Health Economics, Health Financing, or any other relevant field preferably with at least 5 years’ experience.

Key competencies

Technical Competencies

• The holder must possess strong clinical skills

• Research and documentation skills, be able to write an audit proposal, design the methodology of the audit, Skills to write an abstract, report and manuscript

• The incumbent must have knowledge of relevant Healthcare laws, policies and regulations

Behavioral Competencies:

1. Must demonstrate impeccable customer service focus, strategic thinking, and strong ethical background with an ability to resist and zero tolerance for corrupt, political and other undesirable influences;

2. Must be able to establish and maintain constructive and effective relationships with key stakeholders and staff alike;

3. Must be open to change and adapt established methods for new uses within the institution;

Additional Information:

The position is based in Kigali, Rwanda and applicants must be willing to relocate outside their countries of domicile.

RSSB reserves the right to appoint or to issue an employment contract to the successful candidate.

Interested candidates are advised to visit the RSSB website for a more detailed job description for the role, and submit your application online by Tuesday 11, March 2025.

In addition, please attach a curriculum vitae that contains details of your qualifications, experience and positions held relevant to this role. Include your day and evening telephone numbers, email address, names and address of three professional referees. Also, attach copies of your academic and professional qualifications.

Any form of canvassing will lead to automatic disqualification.

Only short-listed applicants will be contacted.

Shortlisted candidates will be required to submit a valid Criminal Clearance Certificate.

RSSB is an Equal Opportunity Employer