Our Client, a leading insurance and financial services company
in East Africa seeks to recruit a Deputy
Medical Claims Manager. (S)He will be reporting to the Medical
Claims Manager.
Main Purpose
To control and manage medical claims processes & procedures through the use
of effective techniques to achieve the objectives of claims cost control,
operational efficiency and meeting of the customer service charter in claims
payment.Main Purpose
Responsibilities:
- Oversight
of the claims process flows to ensure efficiency in processing of claims
as per the company medical claims procedure manuals
- Verification
and audit of outpatient and inpatient claims as per the claims manual and
customer service charter manual to ensure compliance and mitigate risk.
- Negotiate
professional fees and hospital charges including discounts to control
expenditure.
- Oversee
processing, settlement of all claims and authorize requisitions.
- Holding
regular business meetings with service providers to ensure compliance on
contract terms, use of agreed systems and agreed tariffs.
- Monitor,
prevent and control medical claims fraud by carrying out regular audits on
the internal and external systems/ processes as well as providers.
- Supervise,
train and mentor medical claims staff to achieve a high level of
motivation and productivity by the team.
- Prepare
regular claims reports to clients, management and advice underwriter
health on relevant claims findings for medical risk review.
Qualifications:
- Diploma
or Degree in Nursing
- Diploma
in Insurance and or a degree in Health systems Management/ Business
management will be an added advantage
Key Competencies:
- 2
years experience in clinical setting
- At
least 3 years of experience working as a claims team leader in a busy
insurance environment
- Excellent
communication and negotiation skills.
- Excellent
public relations and interpersonal relationship skills.
- Extensive
networking with SP and other medical insurers
- Excellent
analytical and monitoring skills
- User
IT skills in database management and office systems.
- Ability
to evaluate decisions made in benefit utilization management.
- Integrity
and honesty
If you are qualified and up to the challenge, please send applications to kenyanrecruiter@gmail.com, indicating on the subject line the role title.
Please note that only qualified candidates will be contacted.
