Reporting to the Healthcare Administrator-Bancassurance, the role holder will be responsible for day to day engagement with medical providers to ensure quality healthcare provision to members of medical schemes as well as analysis and processing of medical bills submitted for settlement.
Medical Claims Analyst Job Key Responsibilities
Vetting and analyzing medical claims as per scope of cover whilst ensuring strict adherence to set guidelines and TAT
Preparation of members’ reimbursement claims and payment of the credit medical providers
Preparation of utilization reports and other reports as required by member / client24 hour on-call services in management of medical scheme issues and emergency evacuations for medical scheme members country wide
Maintenance of the filing of the medical schemes data/ payment vouchers to ensure proper record keeping
Reconciliation of medical providers’ bills & accounts on an ongoing basis or on demand including visits to providers to sort out contentious bills/ issues
Updating staff medical reimbursements and ensuring all utilizations are captured on a timely basis
Professional assistance to all the staff members/dependants with chronic ailments and facilitating follow up in specialists’ clinics
Qualifications for the Medical Claims Analyst Job
Diploma in Kenya Registered Community Health Nursing nursing/ clinical medicine/ pharmacy and/ or in any medical related background i.e. Pharmacy, medical laboratory or clinical medicine.
At least 3 years’ experience in a busy health Insurance environment with Claims Vetting & Care management background.
Computer literate and familiar with high processing speed using standard office software applications.
Training in Basic and Advance Life Support will be an added advantage.
Desired Skills and Ability
Mature, team player with strong interpersonal and persuasive skills
Good planning and organization skills with the ability to deliver effectively under strict deadlines
Excellent Listening and Communication skills
Accuracy and attention to detail
Ability to develop working relationships with a wide range of internal and external partners
Maintaining strict confidentiality and integrity of all information he/she comes across in the execution of their duties
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