Claims Analyst, Health Business
Job Summary
The role holder will be
responsible for processing of medical claims with a focus on accuracy, cost
containment, risk management, and customer excellence.
Key Responsibilities
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 from 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 the 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 the form of telephone queries, letters,
emails, and walk–in clients.
Maintain
proper department standards, discipline, and confidentiality regarding
patients’ illness.
Qualifications
Bachelor’s
degree/ Diploma in medical, Actuarial, insurance, or business-related discipline
Progress
towards a Diploma in Insurance will be an added advantage
6
months experience in medical claims, insurance/ hospital billing
Competencies
Knowledge
of insurance concepts
Knowledge
of medical claims processes and procedures
Knowledge
of insurance regulatory requirements
Stakeholder
management
Customer
service
Good
Microsoft Excel skills and math aptitude
Delivering
results and meeting customer expectations
Following
instructions and procedures
Coping
with pressures and setbacks
Analysing
Relating
and networking
Presenting
and communicating information
Working
with people
Adhering
to principles and values
Achieving
personal work goals and objectives
How To Apply
If you meet the above
requirements, you are encouraged to forward your application and updated CV to vacancies@heritage.co.ke by
22 October, 2023. Clearly state the job title on the subject heading
