Junior Claims Assesor
On-siteNairobi, Nairobi County, Kenya
Job Summary
Verify and analyze claims and case data against project objectives and payer expectations, then provide detailed feedback to the provider team regarding non-compliant submissions. Ensure general trends and inconsistencies are reported to operations, while timely assessing submitted claims to understand and resolve provider queries. Support the customer call center by addressing escalated medical queries, and document provider practices or disease trends to deliver targeted training. Map generic rules to medical services, procedures, drugs, and lab tests, and participate in testing and documentation of selected client systems. Perform all other duties as assigned by the supervisor. Requires a degree or diploma in clinical medicine or nursing, at least two years of experience in a busy hospital setup, and strong analytical and communication skills.
Required Qualifications
- Degree / Diploma in Clinical medicine or Nursing
- Good understanding of private and public healthcare delivery
- Strong understanding of medical treatment protocols and cost-effective prescribing habits in relation to market segmentation
- At least 2 years' experience in a busy hospital set-up
- Experience in insurance
- Good analytical and problem-solving skills
- Excellent oral and written communication skills
- Strong interpersonal skills with ability to work with cross-cultural and diverse people and teams
- Collaboration and team working skills
- Customer service skills
- Data Entry skills with ability to produce accurate work
- Reporting and good attention to details
- Ability to prioritize and work to meet deadlines
- Flexible and ability to adapt or change to new situations and handle high levels of uncertainty
- Ability to maintain confidentiality
- Personal qualities of integrity, credibility, professionalism, and a commitment to our client's mission
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