Claims Analyst, Health Business, Job in Kenya

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.


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


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


 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 by 22 October, 2023. Clearly state the job title on the subject heading