Jana Matisova

• Accurately assess and process hospital claims in line with governance, regulatory and quality assurance standards
• Act as first line of defence in identifying inappropriate billing, fraud, waste and abuse within hospital claims
• Evaluate claims data to audit outcomes and pinpoint trends, utilising analytical tools to enhance issue resolution strategies and preventive actions
• Identify ineffective or inefficient controls and claims processes, providing recommendations for corrective actions to Senior Management
• Review and maintain policies, procedures and guidelines to ensure documentation remains accurate, current and relevant
• Complete day-to-day duties accurately and efficiently while utilising organisational skills and attention to detail.
• Encourage open communication and mutual respect among team members to facilitate seamless collaboration and support across all levels.
• Engage in daily TPA calls to ensure clear communication and effective resolution of complex issues.
• Ensure continuity of leadership during management leave to maintain team productivity and morale.

Assessed hospital claims to maintain compliance with governance regulations and enhance quality assurance.

Analysed claims data to uncover trends and identify issues requiring remedial and preventive actions.