The National Health Insurance Authority (NHIA), Claims Directorate in Accra climaxed a four-day capacity-building programme on Claims management. This was the last in a series of trainings held across the four Claims Processing Centres (CPCs). The training, funded by the World Bank Programme for Results (P for R) project, brought together staff from the Accra CPC of the Claims Directorate, some selected staff from the Actuarial and Corporate Affairs Directorates.

The initiative, which forms part of a nationwide effort to enhance efficiency, accountability and integrity within the National Health Insurance Scheme (NHIS), is designed to deepen staff understanding of the newly developed e-Claims system, expected to enhance accuracy, reduce dispute and speed up processing.

Participants were also introduced to claims management guidelines, conduct of claims verification exercises, conflict management, matrimonial-related issues under Ghanaian law, cross-cutting operational issues, the NHIA Code of Ethics, code of conduct and disciplinary procedures. Held in two batches, the first group attended sessions on Monday and Tuesday, while the second completed theirs on Thursday, September 18, 2025.

Delivering her presentation on conflict management, Acting Director of Claims, Dr. Abigail Nyarko Codjoe Derkyi-Kwarteng, underscored the importance of viewing conflict not only as a challenge but also as a catalyst for organisational growth when handled constructively. She explained that conflict is an inevitable part of workplace dynamics, especially in institutions as diverse and complex as the NHIA.

However, she noted that the difference between conflict being destructive or productive depends largely on how it is managed. “Conflict, when channelled appropriately, can stimulate creativity, innovation, and better problem-solving. What matters is not avoiding conflict but building the skills to manage it productively,” she said.

Dr. Derkyi-Kwarteng highlighted practical approaches for resolving conflicts including forcing, accommodating, avoidance and compromise. She stressed that managers and staff must cultivate the needed conflict resolution skills to maintain harmony while ensuring accountability in claims management. She also encouraged participants to ultimately adopt a collaborative approach, where issues are resolved in ways that preserve relationships and strengthen institutional trust.

Dr. Abena Ekufua Esia-Donkoh, Deputy Director, Claims at CPC Cape Coast, addressed updates in claims management guidelines, focusing on clinical inappropriateness. She cited common errors such as diagnosis-treatment mismatches, missing attachments, and system-related duplicates, urging staff to prioritise accuracy, compliance, and integrity to ensure claims are legitimate and adjudicated efficiently.

She further stressed the need for careful vetting of claims submitted by stand-alone laboratories and pharmacies, noting that such facilities often present unique challenges that require strict scrutiny to prevent errors and abuse.

Acting Director of Operations, Ms. Mariam Musah, led a session on cross-cutting operational issues, noting challenges such as illegal payments, fraud, abuse, and tariff review/system integrity. She said management is scaling up clinical audits while preparing to deploy advanced tools. “Beyond the audits, we are moving towards the use of artificial intelligence and fraud detection systems in both our claims management and data analysis processes,” she announced.

Ms. Musah emphasised the crucial role of the Claims Directorate in safeguarding the scheme’s integrity, urging staff to be vigilant in detecting discrepancies and to reinforce this vigilance during engagements with providers.

The training also featured a session led by Baba Sadique Zankawah (Esq.), Acting Director of Infrastructure, who took staff through synopsis on matrimonial causes and related matters under Ghanaian law and their relevance to claims management. His presentation addressed sensitive areas such as marriage, breach of promise, divorce, spousal abuse, child custody, spousal support, property distribution, and inheritance. On conduct of claims verification guidelines,

Mr. Isaac Gideon Akonde, Acting Director of the Co-payment Taskforce, urged diligence, accuracy, and consistency in reviewing claims, stressing integrity and professionalism in provider interactions.

Participants were also taken through the NHIA Code of conduct, ethics and disciplinary procedures, reminding them of their responsibility to uphold professionalism and accountability.

Mr. Eric Kobla Nazar, a manager at the Claims Directorate, briefed participants on systems support updates, outlining recent developments, challenges, and solutions. He highlighted practical strategies to improve efficiency, strengthen data security, and ensure seamless service delivery. He also introduced the new Patient Call-Out feature, an innovation designed to improve communication, facilitate claims verification, and boost overall efficiency.

As part of the training, participants engaged in group work, asked questions, and sought clarifications. The interactive discussions encouraged open dialogue, allowing staff to share experiences, address concerns, and deepen their understanding of the issues raised.

Source: Vivian Arthur

Photo: Samuel Larbi