About the job
Purpose of the Job
Develop and oversee the claims management strategy for healthcare business that ensures medicalclaims management is in line with the business strategic plan.
Duties and Responsibilities
Develop policies and procedures that guide the management of medical claims to ensure compliancewith the specific client’s service level agreements as well as insurance regulations.
Develop processes for claims management to support efficiency and effectiveness – Processing andPayment of claims to all providers in line with the standard service agreement as well as thecontractual agreement therein.
Claims Review and Approval – Review claims processed to ensure that all claims fall within scope ofrespective medical insurance policy and comply with claims management policies and procedures.
Attend to escalated and complex medical claims to ensure these are attended to in a timely manner,and that they do not expose the business to any risk.
Risk Supervision – Overall process management to shield the company from any potential liabilityemanating from claims processing.
Business Advisory – Monitor and review claims trends and provide necessary advisory to thebusiness for decision-making, innovation, and strategy review.
Claims Records management & Reporting.
Continuous process Audit and Fraud management
People Management – Develop staff by sharing knowledge, mentoring, coaching, and training and toensure full range of performance management processes and procedures.
Qualification
Degree in Nursing, Clinical Medicine or Pharmacy
Professional qualification in Insurance (AIIK or ACII) will be an added advantage.
7 years in health insurance operations 3 of which must be in a managerial role.
Competencies
Knowledge of insurance industry and concepts
Knowledge of insurance regulatoryrequirements
Formulation of strategies and concepts
Business management skills
Strong personality with interpersonal sensitivity
Leadership skills
Quality decision making skills.
Listening skills
Conflict handling skills
Presentation skills
Good written and verbal communication skills
Proactive
Team player
Strong negotiation skills
Creative & open-minded
High level of numeracy and strong analytical skill
How to ApplyInterested candidates who meet the above qualifications to send their applications to recruitmentkenya@minet.co.ke Please indicate the job title as the subject. Only shortlisted candidates will be contacted.
Apply via :
recruitmentkenya@minet.co.ke
www.linkedin.com
