Claims Manager Jobs In Kenya

Claims Manager Job , Medical Kenya Jobs 2021,

Develop and oversee the claims management strategy for healthcare business that ensures medical claims 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 compliance with the specific client’s service level agreements as well as insurance regulations.
  • Develop processes for claims management to support efficiency and effectiveness – Processing and Payment of claims to all providers in line with the standard service agreement as well as the contractual agreement therein.
  • Claims Review and Approval – Review claims processed to ensure that all claims fall within scope of respective 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 liability emanating from claims processing.
  • Business Advisory – Monitor and review claims trends and provide necessary advisory to the business 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 regulatory requirements
  • 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 Apply

Interested candidates who meet the above qualifications to send their applications to recruitmentkenya@minet.co.ke.

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