Claims Analyst
On-siteNairobi, Nairobi County, Kenya
Job Summary
Review, assess, and authenticate outpatient and inpatient claims while scanning, barcoding, and batching received data. Process reimbursements within set turnaround times, conduct quality assurance before pay runs, and manage pended or declined claims by notifying brokers and clients. Liaise with agents, brokers, and service providers on claim matters, ensure document archiving in the Medware system, and monitor NHIF enhanced benefits and roaming claims. Generate daily status reports, address client queries via phone, letters, and walk-ins, and maintain department standards and confidentiality. Maintain claims production targets and adhere to insurance regulatory requirements.
Required Qualifications
- Bachelor's degree/ Diploma in medical, insurance or business-related discipline
- 1 years' experience in medical claims management in insurance/hospital setting
- Knowledge of insurance concepts
- Knowledge of medical claims processes and procures
- Knowledge of insurance regulatory requirements
- Stakeholder management
- Customer service
- Good Microsoft Excel skills and math aptitude
- Delivering results and meeting customer expectations
- Interpersonal skills
- Planning and organizing
- Presenting and communicating information
- Persuading and influencing
- Supervisory skills
- Adhering to principles and values
Desired Qualifications
- Progress towards Diploma in Insurance will be an added advantage
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