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Job Description

Job description

To ensure prompt and fair settlement of all medical claims in accordance with the claims manual and guidelines in order to control claims expenditure and also maintain a good working relationship with service providers

KEY PRIMARY RESPONSIBILITIES

Vetting and analyzing medical claims as per the scope of cover whilst ensuring strict adherence to set guidelines and TAT 

Monitors service providers’ claims through analytics in view of ensuring they maintain high standards of service delivery 

Reconciliation of medical providers’ bills & accounts on an ongoing basis or on-demand including visits to providers to sort out contentious bills/ issues 

ACADEMIC QUALIFICATIONS

Diploma in Kenya Registered Community Health Nursing/ Clinical medicine/ pharmacy and/ or in any medical-related qualifications. 

JOB SKILLS AND REQUIREMENTS

Computer literate and familiar with high processing speed using standard office software applications 

Team player with strong interpersonal and persuasive skills 

Good Communication and interpersonal skills

Good analytical skills and keenness to details

Excellent Negotiation skills

Effective decision maker

PROFESSIONAL QUALIFICATIONS

Certificate of Insurance Proficiency or any Insurance-related qualifications

EXPERIENCE

At least 3 years’ experience in a busy health Insurance environment with a Claims Vetting & Care management background 

How To Apply

Interested and qualified candidates should send their applications to [email protected] and [email protected] for Software Development role

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