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Job Vacancies in Resolution Health Kenya

Resolution Insurance Company Ltd is a general insurer offering innovative and responsive insurance solutions. 

We have learned to adapt in this constantly changing society, and develop comprehensive products that are relevant to our clients. 

We currently have over 60,000 members in our fold and have partnered with over 500 medical service providers across East Africa; a strong network of hospitals, clinics and doctors.

The Resolution Insurance brand is energetic and trendy. 

In pursuit of our ambitious growth plan, we are looking to fill the below position in our General Business Department. 
Senior Claims Analyst
The Senior Claims Analyst’s overall purpose is to attend to all activities of the claims department in the processing of insurance claims to achieve prompt, efficient, equitable and accurate processing and settlement. 

Effective claims service is a key area of opportunity to achieve profitable growth in our market.
The jobholder will be expected to demonstrate leadership and professionalism and perform all duties in accordance with the organization’s policies and procedures, keeping in mind the overall business objectives

Key Outputs
  • Ensure that claims are received, registered and acknowledged in a timely manner and maintain organized claim files.
  • Ensure reserving is done and updated upon receipt of any new information
  • Ensure timely and appropriate scanning and filing of claims records
  • Ensure savings on all claims
  • Appointment of Service providers up to the authorized limit in liaison with the Technical Manager and monitor progress to ensure reports are received promptly
  • Maintain good communication with Service providers and ensure their compliance with set service level agreement
  • High level of customer service - ensure Customers are updated on their claim’s status at all times
  • Communicate with intermediaries and direct clients to obtain information necessary for processing of claims, liaise with the underwriters, beneficiaries, departments and subsidiary offices to facilitate claims processing
  • Identify risk improvement measures and prepare suitable interventions and make recommendations to the management/underwriting department
  • To prepare relevant departmental and management reports for analysis by the 5th of every month including any emergent risks
  • Training of Claims staff on policies, products and claims processes.
  • Any other duties assigned by the Manager.
Qualifications & Experience

  • Diploma in a business related field
  • CII/IIK diploma
  • At least 5 years relevant experience
  • Knowledge of Microsoft Office with excellent skills in Excel.
  • Good analytical and problem solving skills.
  • Good time management and organizational skills.
If you believe you are a team player and would be a valuable resource to this ever growing brand, kindly CLICK HERE to apply online by COB, Wednesday, 27th May 2015.

Claims Adjudicator
Reporting to the Assistant Claims Manager, the Claims Adjudicator’s purpose is to ensure that claims are processed correctly and identify overcharged / fraudulent claims in order to save the company money.

Key Responsibility Areas: 

 1) Receive and analyze claims for processing 

2) Vet and adjudicate claims for payment 

3) Resolve and reconcile problems related to claims, by liaising with the providers 

4) Escalation of non-resolved issues to MSP relations within 7 days of initial contact with MSP 

5) Prepare the relevant departmental reports 

6) Communicate with clients or MSPs regarding claims.

Qualifications and Experience:
  • Diploma in a clinical medicine or Nursing.
  • KRCHN or KRN/M Certification.
  • At least 3 years relevant experience in health management.
  • In-depth knowledge of health management
  • Computer skills including knowledge of Microsoft Office.

If you believe you are a team player and would be a valuable resource to this ever growing brand, kindly CLICK HERE to apply online by COB, Wednesday, 27th May 2015.

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