Medical Claims Analyst

About the Role

CIC Africa Insurance (SS) Ltd, a subsidiary of CIC Insurance Group is looking to recruit highly skilled individuals to fill the position of Medical Claims Analyst to be based in the Head Office in Kenya. Reporting to the Medical Supervisor – Claims & Care Service Management, the role holder will be responsible vetting both in/ outpatient medical claims for payment.

Key Responsibilities

• Vet in/outpatient medical bills/invoices and refer any suspicious claims to the supervisor; 
• Batch outpatient invoices on the system and adjust amount payable as per the vetting findings; 
• Check and reject incomplete invoices and return with supporting documents to service providers. 
• Negotiate, adjust and update service providers on their costs and accounts status;  
• Reconcile statements of accounts for service providers; advising accounts and service providers on unpaid/underpaid bills; 
• Review claims reserves on a continuous basis in view of new developments;  
• Attend to customer queries and complaints promptly and professionally and 
• Recommend risk improvement measures to the underwriter to take appropriate action. 

Who We’re Looking For

Essential Knowledge/Skills and Experience Required:

• Bachelor’s degree in a related field or a Diploma in Nursing / Diploma in Clinical Medicine. 
• Minimum of 3 years of relevant experience. 
• Registered Nursing, Diploma – Required  
• Excellent communication and presentation skills 
• Problem solving skills 
• Excellent interpersonal skills  
• Good negotiation skills 
• Good analytical skills 
• Computer literate in MS Office and other office applications 
• Understanding of the working environment /competitors 
• Technical competence in insurance  
• Basic knowledge of regulations by the regulators