Key Areas of Responsibility

• Review, assess, authenticate and capture outpatient and inpatient claims as per the claims manual and within the set TATs
• Timely scanning, barcoding and batching of received claims
• Processing of reimbursements within the set TATs
• Conduct quality assurance process before batches are authorized for pay run
• Notify brokers and clients of pended and declined claims within set timelines
• Manage pended and declined claims
• Liaise with agents, brokers and service providers on matters arising on claims
• Ensure all claims documents are archived in the relevant systems
• Maintain claims production within set targets
• Generate daily health claims status report
• Storage of all correspondence in Medware system
• Monitoring and processing of NHIF enhanced benefits for cost containment
• Recording and monitoring of roaming and counter-guarantee claims.
• Customer service – address clients’ queries in form of telephone queries, letters, emails and walk –in clients.
• Maintain proper department standards, discipline and confidentiality regarding patients’ illness

Requirements

Minimum Qualifications:

• Bachelor’s degree/ Diploma in medical, insurance or business-related discipline
• Progress towards Diploma in Insurance will be an added advantage.
• 1 years’ experience in medical claims management in insurance/hospital setting

 Core Competencies

• 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

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