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
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
Certificate of Insurance Proficiency or any Insurance-related qualifications
At least 3 years’ experience in a busy health Insurance environment with a Claims Vetting & Care management background
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