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Claims Analyst, Health Business

Nairobi,Kenya
This Job has Expired
Company Details
Industry: Insurance
Description: At Heritage where we provide short term insurance products, we pride ourselves on our history of claims payment. This was recently recognized when we won the award for Outstanding Insurance Underwriter in Claims Settlement as nominated by members of the Association of Insurance Brokers of Kenya. We are also rated AA- by Global Rating Company (GRC), for amongst other reasons, our high claims paying ability. This is one of the highest international ratings awarded to a Kenyan insurer.
Job Description

Job Summary

The role holder will be responsible for processing of medical claims with a focus on accuracy, cost containment, risk management and customer excellence.

Key Responsibilities

  •  Review, assess, authenticate and capture outpatient and inpatient claims as per the claims manual and within the set TATs
  •  Timely scanning, barcoding and batching of received claims
  •  Processing of reimbursements within the set TATs
  •  Conduct quality assurance process before batches are authorized for pay run
  •  Notify brokers and clients of pended and declined claims within set timelines
  •  Manage pended and declined claims
  •  Liaise with agents, brokers and service providers on matters arising on claims
  •  Ensure all claims documents are archived in the relevant systems
  •  Maintain claims production within set targets
  •  Generate daily health claims status report
  •  Storage of all correspondence in Medware system
  •  Monitoring and processing of NHIF enhanced benefits for cost containment
  •  Recording and monitoring of roaming and counter-guarantee claims.
  •  Customer service – address clients’ queries in form of telephone queries, letters, emails and walk–in clients.
  •  Maintain proper department standards, discipline and confidentiality regarding patients’ illness.

Qualifications

  • Bachelor’s degree/ Diploma in medical, Actuarial, insurance or business-related discipline
  • Progress towards Diploma in Insurance will be an added advantage

Experience

  • 6 months experience in medical claims, insurance/ hospital billing

Competencies

  • Knowledge of insurance concepts
  •  Knowledge of medical claims processes and procedures
  •  Knowledge of insurance regulatory requirements
  •  Stakeholder management
  •  Customer service
  •  Good Microsoft Excel skills and math aptitude
  •  Delivering results and meeting customer expectations
  •  Following instructions and procedures
  •  Coping with pressures and setbacks
  •  Analysing
  •  Relating and networking
  •  Presenting and communicating information
  •  Working with people
  •  Adhering to principles and values
  •  Achieving personal work goals and objectives.

 

Education: Degree, Diploma
Employment Type: Contract Based
Contact Information
Name: Hiring Kenya

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