Junior Claims Assessor - 2 Months Temporary Contract
Hybrid · Nairobi, Nairobi County, Kenya
Job Summary
Junior Claims Assessor responsible for vetting medical claims and cases, ensuring accuracy, eligibility, and clinical appropriateness; applying deductions, exclusions, and negotiated rates; identifying savings opportunities; escalating high-cost or non-standard claims; mapping diagnoses, procedures, drugs, and investigations to correct codes and benefits; reconciling claims with medical reports and documentation; preparing clear reports on deductions, savings, and trends; coordinating with providers, case managers, and operations teams; and supporting audit and continuous improvement activities.
Required Qualifications
- Degree or Diploma in Nursing, Clinical Medicine, Pharmacy, Medicine, or another related health qualification
- Valid registration with the relevant professional body in Kenya
- At least 2-4 years of experience in a busy clinical setting
- Good understanding of medical insurance claims
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