° We have big ambitions and require a Insurance Claims & Reconciliation Officer at our hospital. Reporting to our Finance Manager, you will take on responsibility of delivering quality customer service and maintaining superior patient satisfaction. 

° Will you join us and help transform maternal and new-born health care in East Africa?

Key Duties & Responsibilities:

Claims Management

° Collect, verify, and prepare insurance claims with supporting documents (invoices, pre-authorizations, medical reports);

° Submit claims to insurers within stipulated timelines and monitor acknowledgment of receipt;

° Track claims at every stage to ensure timely settlement;

° Maintain an updated claims register with details of claims submitted, amounts, dates, and statuses;

Reconciliation & Payment Processing

° Reconcile insurer remittances against submitted claims, ensuring accuracy and completeness;

° Investigate and resolve variances, rejections, partial payments, or delays in settlement;

° Prepare reconciliation statements and submit to the Finance Manager;

° Work with Accounts Receivable to ensure insurance payments are correctly posted;

Follow-Up & Dispute Resolution

° Liaise with insurance companies and third-party administrators to resolve disputed or pending claims;

° Escalate unresolved claim issues to management for intervention;

° Maintain strong working relationships with insurer contacts to facilitate quick resolution;

Compliance & Risk Management

° Ensure all claims adhere to hospital policies, insurer requirements, and regulatory standards;

° Monitor and report on trends in claim rejections or denials, recommending preventive measures;

° Safeguard confidentiality of patient and insurer information in line with data protection regulations;

Reporting & Analysis

° Prepare periodic reports on claims submitted, amounts recovered, outstanding balances, and rejection trends;

° Provide management with insights on performance of different insurers and highlight areas of concern;

° Support preparation of monthly, quarterly, and annual financial reports related to insurance recoveries;

Stakeholder Coordination & Process Improvement

° Collaborate with clinical, billing, and administrative teams to ensure accurate patient data and claim documentation;

° Train or sensitize staff on proper documentation practices to reduce claim rejections;

° Recommend process improvements to reduce turnaround times and increase claim recovery efficiency;

° Keep updated with changes in insurance policies, tariffs, and regulations, and advise management accordingly;

Any other duties as may be assigned.

Qualifications:

° Bachelor’s degree in Accounting, Finance, Business Administration, or related field;

° Professional qualification such as CPA, ACCA, or equivalent is an added advantage;

° A nurse or clinical officer with experience in medical insurance claims management in a reputable insurance company will also be considered;

° At least 3–5 years’ experience in insurance claims processing, healthcare finance, or medical billing;

° Strong understanding of insurance claim cycles, healthcare schemes, and billing processes;

° Proficiency in MS Excel, accounting systems, and ERP platforms;

° Previous experience in a hospital or insurance company environment preferred;