Job Details

  • Deadline: 28th July , 2026.
  • Company: NHIMA
  • Location: Zambia
  • Employment Type: Full-Time
  • Category: Administrative/Secretarial Jobs in Zambia
  • Application: Online application

Job Description

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Company

NHIMA

Location

Zambia

State

Lusaka

Job type

Full-Time

Job category

Administrative/Secretarial

Job Description

Key Responsibilities

Job

Summary

The role is responsible for implementing NHIMA’s accredited facilities Inspections, Clinical and Claims Audit Strategy to ensure compliance with quality protocols in line with the NHI ACT No.2 of 2018.

Reporting to the office of the Director Quality Assurance and Accreditation, the role will ensure that Clinical/Claims audit policy is implemented including monitoring and reporting, investigating incidents and defining and enforcing corrective measures. The role will require extensive travel within Zambia as part of the inspections process.

The key functions of the role will include but not limited to

Stakeholder & Facilities Outcomes

Provide technical oversight to clinical/claims audits of accredited healthcare facilities, and reporting.

Ensure accredited HCPs comply with Clinical Guidelines/Protocols and Standards.

Monitor and Evaluate adherence to NHIMA Claim Guidelines and Protocols

Facilitate and provide technical input stakeholder engagement activities aimed at enhancing quality of insured health services provided

Recommend for post audit relevant suctions to health care providers.

Communicate findings and recommendations of clinical/claims audits to Director Quality Assurance and Accreditation, Management Accreditation committee, QAA committee of the board, Ministry of Health, accredited facility and other relevant bodies.

Finance & Solvency Outcomes

Facilitate clawback of fraudulent and erroneously claimed reimbursements

Development of Clinical Inspections Unit Annual Work Plan

Provide technical oversight to the quarterly monitoring and evaluation of Annual Work Plan implementation

Provide input to the QAA Departmental Annual Work Plan

Represent the Unit in departmental trainings and continuous professional development to build dynamic capacity to conduct clinical audits and fraud investigations to assigned HCPs in line with the Authority policies.

Systems and Control Outcomes

Design and implement customised data collection tools for clinical audit and fraud investigations using relevant background information and criteria

Monitor and Evaluate claim data to identify potential clinical/claims audits

Maintain clinical/claims audit database and audit reports

Identify and implement relevant internal control procedures to safeguard the Authority Fund

Undertake any task/assignment which the supervisor may delegate from time to time.

Education Requirements

Knowledge, Skills, Qualifications and Experience

Must have Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language.

A Bachelor’s Degree in Medicine and Surgery, A degree in Clinical Medicine, Pharmacy or its equivalent from a recognized training institution.

A postgraduate degree in Project Management, Business Administration, Public Health, Clinical Medicine, or its equivalent will be an added advantage

Must have at least 5 years in a similar role

Required Skills

Competencies required for this Role

Must be familiar with the tools of monitoring and evaluation as part of the inspection processes.

Must be familiar with accepted general health and medical standards in Zambia

Track record of achieving targets with a consistent high level of quality.

Ability to liaise with different teams and at different management levels; and

Must have strong leadership and supervisory skills and able to lead teams effectively.

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Method of Application

Submit your CV and Application on Company Website: Click Here

Closing Date: 28th July, 2026.

How to Apply

Apply online: Open application link