Job Ref. No: JHIL080
Role
Purpose
The job holder will be responsible for ensuring efficient
processing and assessment of inpatient medical claims within the organization
and ensuring accurate assessment and processing of medical claims, ensuring
fair and efficient reimbursement while maintaining compliance with regulatory
guidelines and adhering to company policies.
Main Responsibilities
Strategy
Support the development and
implementation strategies to optimize the claims assessment process and enhance
efficiency.
Identify areas for process improvement
and make recommendations for streamlining workflows.
Stay updated with industry trends and
changes in healthcare regulations to ensure compliance and mitigate risks.
Operational
Review and assess medical claims,
verifying the accuracy of information provided.
Apply knowledge of medical procedures,
diagnoses, and coding systems to determine the validity and eligibility of
claims.
Evaluate medical records, invoices,
and other relevant documentation to determine the appropriateness of
reimbursement.
Communicate with healthcare providers,
policyholders, and internal teams to gather additional information or clarify
claim details.
Adhere to predefined timelines and
service level agreements for claims assessment and resolution.
Collaborate with internal teams such
as underwriting, finance, and customer service to address claim-related queries
and issues.
Corporate
Governance
Ensure compliance with company
policies, procedures, and regulatory guidelines.
Maintain confidentiality and handle
sensitive information in accordance with data privacy laws and regulations.
Adhere to ethical standards and
maintain professional conduct while dealing with confidential or sensitive
matters.
Key Competencies
In-depth knowledge of medical
terminology, healthcare procedures, and coding systems.
Strong analytical and problem-solving
skills.
Attention to detail and ability to
maintain accuracy while processing complex information.
Excellent communication and
interpersonal skills.
Ability to work independently and
manage time effectively.
Critical thinking and decision-making
abilities.
Knowledge of insurance industry
practices and claim adjudication processes.
Adaptability and flexibility to handle
changing priorities and work in a fast-paced environment.
Qualifications
Bachelor’s degree in a business,
insurance or clinical related field
Good understanding of the concepts of
medical insurance
Proficient in the use of Microsoft
office suite and packages
Proficient in use of Actisure system
Relevant
Experience
Minimum of 4 years’ experience in a
similar role.
How To Apply
If you are qualified and seeking an exciting new
challenge, please apply via Recruitment@jubileekenya.com quoting
the Job Reference Number and Position by 20th
March 2024 Only shortlisted candidates will be contacted.