Job Ref. No: JHIL080 (Re-advertised)
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.Only shortlisted candidates will
be contacted.