Senior Medical Claims Assessor – Inpatient Claims at

2 weeks ago

Nairobi, Nairobi Area, Kenya Jubilee Insurance Full time
Jubilee Insurance was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa in 1937.

Jubilee Insurance has spread its sphere of influence throughout the region to become the largest Composite insurer in East Africa, handling Life, Pensions, general and Medical insurance.

Job Ref

No:
JHIL080 (Re-advertised)
Role Purpose

The job holder will be responsible for ensuring efficient processing and assessment of inpatient medical claims within the organization and ensuring accurate assessment and processing of medical claims, ensuring fair and efficient reimbursement while maintaining compliance with regulatory guidelines and adhering to company policies.

Main Responsibilities
Strategy

Support the development and implementation strategies to optimize the claims assessment process and enhance efficiency.
Identify areas for process improvement and make recommendations for streamlining workflows.
Stay updated with industry trends and changes in healthcare regulations to ensure compliance and mitigate risks.

Operational

Review and assess medical claims, verifying the accuracy of information provided.
Apply knowledge of medical procedures, diagnoses, and coding systems to determine the validity and eligibility of claims.
Evaluate medical records, invoices, and other relevant documentation to determine the appropriateness of reimbursement.
Communicate with healthcare providers, policyholders, and internal teams to gather additional information or clarify claim details.
Adhere to predefined timelines and service level agreements for claims assessment and resolution.
Collaborate with internal teams such as underwriting, finance, and customer service to address claim-related queries and issues.

Corporate Governance

Ensure compliance with company policies, procedures, and regulatory guidelines.
Maintain confidentiality and handle sensitive information in accordance with data privacy laws and regulations.
Adhere to ethical standards and maintain professional conduct while dealing with confidential or sensitive matters.

Requirements
Key Competencies

In-depth knowledge of medical terminology, healthcare procedures, and coding systems.
Strong analytical and problem-solving skills.
Attention to detail and ability to maintain accuracy while processing complex information.
Excellent communication and interpersonal skills.
Ability to work independently and manage time effectively.
Critical thinking and decision-making abilities.
Knowledge of insurance industry practices and claim adjudication processes.
Adaptability and flexibility to handle changing priorities and work in a fast-paced environment.

Qualifications

Bachelor's degree in a business, insurance or clinical related field
Good understanding of the concepts of medical insurance
Proficient in the use of Microsoft office suite and packages
Proficient in use of Actisure system

Relevant Experience

Minimum of 4 years' experience in a similar role

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