• The Claims Registrar will be responsible for the efficient assessment and registration of claims in strict adherence to established standards, policies, and procedures. The role requires a keen eye for detail, ensuring accuracy and compliance throughout the claims process. Additionally, the role holder will be expected to maintain a high level of productivity by consistently meeting daily targets, demonstrating both efficiency and reliability in delivering quality service.
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Main Responsibilities

Operational

• Verification of Member and Provider Details – Thoroughly review and confirm the accuracy of member, scheme, and provider information before data entry to ensure seamless claims processing.
• Precise Data Capture – Accurately input claim details into the system from claim documents, minimizing errors and maintaining data integrity.
• Efficient Claims Indexing – Systematically categorize and index claims using the Invoice ID for easy retrieval and streamlined processing.
• Quality Control for Scanning – Identify and flag claims requiring rescanning due to poor legibility, ensuring that all records are clear and complete for assessment.
• Collaborative Issue Resolution – Engage experienced staff for guidance and clarification on complex cases, ensuring claims are processed correctly and efficiently.
• Claims Validation and Vetting – Carefully assess the validity of services provided by verifying treatment details, benefit coverage, provider panel adherence, and treatment costs to uphold compliance and prevent discrepancies.
• Communication and Notation – Utilize the Notes function to alert approvers of any irregularities or notable observations during the registration process, enhancing transparency and decision-making.

Corporate Governance

• Ensure strict adherence to industry regulations, insurance claims protocols, and corporate policies to safeguard the organization’s integrity and mitigate legal risks.
• Uphold the laws and regulations of Kenya, including insurance claims procedures, anti-fraud measures, and internal risk controls, while ensuring company policies are implemented consistently across all claims processes.
• Ensure all claim-related documentation is accurate, secure, and audit-ready, minimizing exposure to fraud and regulatory penalties.

Culture

• Promote ethical decision-making in claims adjudication, ensuring claimants are treated with respect and fairness while upholding the company’s reputation as a responsible corporate citizen.
• Champion initiatives that enhance employee engagement, resilience, and a shared commitment to excellence.
• Create personalized development plans that align with your career aspirations and the organization's objectives

Key Competencies

• Strong background in medical claims assessment, including knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and treatment procedures.
• Experience working with insurance regulatory compliance, fraud detection, and risk mitigation in claims processing.
• Familiarity with policy interpretation and customer service in handling claims disputes and resolutions.
• Proficiency in claims management systems and data analysis tools used in health insurance.
• Hands-on experience coordinating with healthcare providers, underwriters, and legal teams to validate and process claims efficiently.

Academic and Professional Qualifications

• Bachelor's degree /Diploma in Nursing, Clinical Medicine, Healthcare Management, or a related field.
• Relevant certifications in customer service or customer experience are advantageous.

Relevant Experience

• At least 1 year of experience in health insurance claims processing, adjudication, or claims management.