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Claims Adjudicator Job in Kenya

Resolution Health East Africa Limited is a leading Medical Insurance Provider. With over 60,000 members in our fold, we have learnt to adapt in this constantly changing society, and develop products that are effective and relevant to our members. Resolution Health has over 250 medical service providers all across East Africa, a strong network of hospitals, clinics and doctors. 
The Resolution Health brand is energetic and trendy. In pursuit of our ambitious growth plan, we are looking to enroll as part of our Claims Team an individual who has analytical skills with excellent planning and organizational skills and who can contribute by being an effective team player and is capable of maintaining positive, professional relationships with our medical service providers.

Application Deadline

Job Details
Reporting to the Claims Supervisor, the Claims Adjudicator’s role is to timely and correctly process claims ensuring cost containment and adherence to company policies. 
Key Responsibility Areas:
1. To receive and analyze claims for processing;
2. To vet and adjudicate claims for payment;
3. To resolve problems related to claims, by liaising with providers, so as to allow vetting and adjudication;
4. Escalation of non resolved issues with MSPs to MSP relations within 7 days of initial contact with MSP;
5. To reconcile disputed claims with providers so as to allow payment
6. To prepare relevant departmental and management reports for analysis by the 5th of every month

The right candidate must have the following:
Diploma in Nursing or Clinical Medicine
Knowledge of MS Office – A Must.
3 years experience in care management in a large modern hospital
In-depth knowledge of care and health management an added advantage
Excellent communication and interpersonal skills

If you believe you are a team player and would be a valuable resource to this ever growing brand, kindly email your application letter, updated CV listing three references with their email or phone contacts, your age and expected remuneration package not later than Wednesday 23rd February 2011 to
Ensure that you quote the position on your email.
Only shortlisted candidates will be contacted.
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