Job Summary
The role holder will be responsible for processing of medical claims with a focus on accuracy, cost containment, risk management and customer excellence.
Key Responsibilities
Review, assess, authenticate and capture outpatient and inpatient claims as per the claims manual and within the set TATs
Timely scanning, barcoding and batching of received claims
Processing of reimbursements within the set TATs
Conduct quality assurance process before batches are authorized for pay run
Notify brokers and clients of pended and declined claims within set timelines
Manage pended and declined claims
Liaise with agents, brokers and service providers on matters arising on claims
Ensure all claims documents are archived in the relevant systems
Maintain claims production within set targets
Generate daily health claims status report
Storage of all correspondence in Medware system
Monitoring and processing of NHIF enhanced benefits for cost containment
Recording and monitoring of roaming and counter-guarantee claims.
Customer service – address clients’ queries in form of telephone queries, letters, emails and walk–in clients.
Maintain proper department standards, discipline and confidentiality regarding patients’ illness.
Qualifications
Bachelor’s degree/ Diploma in medical, Actuarial, insurance or business-related discipline
Progress towards Diploma in Insurance will be an added advantage
Experience
6 months experience in medical claims, insurance/ hospital billing
Competencies
Knowledge of insurance concepts
Knowledge of medical claims processes and procedures
Knowledge of insurance regulatory requirements
Stakeholder management
Customer service
Good Microsoft Excel skills and math aptitude
Delivering results and meeting customer expectations
Following instructions and procedures
Coping with pressures and setbacks
Analysing
Relating and networking
Presenting and communicating information
Working with people
Adhering to principles and values
Achieving personal work goals and objectives
go to method of application »
If you meet the above requirements, you are encouraged to forward your application and updated CV to vacancies@heritage.co.ke by 22nd October, 2023. Clearly state the job title on the subject heading
Apply via :
vacancies@heritage.co.ke
