Job description
To ensure prompt and fair settlement of all medical claims in accordance with the claims manual and guidelines in order to control claims expenditure and also maintain a good working relationship with service providers
KEY PRIMARY RESPONSIBILITIES

Vetting and analyzing medical claims as per the scope of cover whilst ensuring strict adherence to set guidelines and TAT 
Monitors service providers’ claims through analytics in view of ensuring they maintain high standards of service delivery 
Reconciliation of medical providers’ bills & accounts on an ongoing basis or on-demand including visits to providers to sort out contentious bills/ issues 

ACADEMIC QUALIFICATIONS

Diploma in Kenya Registered Community Health Nursing/ Clinical medicine/ pharmacy and/ or in any medical-related qualifications. 

JOB SKILLS AND REQUIREMENTS

Computer literate and familiar with high processing speed using standard office software applications 
Team player with strong interpersonal and persuasive skills 
Good Communication and interpersonal skills
Good analytical skills and keenness to details
Excellent Negotiation skills
Effective decision maker

PROFESSIONAL QUALIFICATIONS

Certificate of Insurance Proficiency or any Insurance-related qualifications

EXPERIENCE

At least 3 years’ experience in a busy health Insurance environment with a Claims Vetting & Care management background