Duties and Responsibilities
The Claims Analysts will vet and authorize claims to ensure treatment protocols and policy guidelines are followed for the respective products with the end result of business profitability and customer satisfaction. They will do this as they also perform the following functions:
Vetting all claims to ensure that they are within the scope of cover for the various schemes
Generate outpatient claim analysis reports and make recommendations to management on areas of improvement as required.
Ensuring that accurate data is captured into the system at all times.
Respond to queries raised by service providers and customers within 24 hours.
Facilitation of service provider reconciliations through the claims supervisor.
Ensuring all claims returns are done within agreed timelines on a weekly basis.
Preparing claims reports and any other report that may be assigned thereof.
Ensure all claims for service providers are ready for payment within the set timelines for the specified providers.
Monthly service provider reconciliations through the claims supervisor assigned within agreed timelines
Enhancing good relationships with service providers through excellent customer service.
Qualifications, Experience and Competencies
Qualified candidates are required to possess the following qualifications, experience, and personal attributes:
Bachelor of Science (Nursing) Degree or Diploma in Nursing
2 years’ experience in a large hospital or insurance company
Knowledge of health insurance benefits
Knowledge of medical treatment protocols
People management skills of both external and internal partners
Good communication skills
Good problem-solving skills.
Applications should be addressed to the Group Human Resources Manager, Madison Group Limited, Email:hr_recruitment@madison.co.ke so as to be received by Friday 11th February 2022.
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