Job Title:         Claims Analyst       

Location:        Nairobi  

Profile Introduction            

Our client, a leading
financial and health insurance company seeks to bring on

board an Claims Analyst. The role will be responsible for processing medical
claims

with a focus on accuracy, cost
containment, risk management and customer

excellence.

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