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Claims Analyst at

1 month ago

Nairobi, Nairobi Area, Kenya Stratostaff Full time

At Stratostaff we design, implement and manage workforce solutions for large, specialized or routine staff complements giving you the opportunity to focus on your core business.

At Stratostaff we design, implement and manage workforce solutions for large, specialized or routine staff complements giving you the opportunity to focus on your core business.

Profile Introduction

Our client, a leading financial and health insurance company seeks to bring on board an Claims Analyst.

The role will be responsible for processing medical claims with a focus on accuracy, cost containment, risk management and customer excellence.

Key Areas of Responsibility

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

Requirements

Minimum Qualifications:
Bachelor's degree/ Diploma in medical, insurance or business-related discipline
Progress towards Diploma in Insurance will be an added advantage.
1 years' experience in medical claims management in insurance/hospital setting

Core Competencies

Knowledge of insurance concepts
Knowledge of medical claims processes and procures
Knowledge of insurance regulatory requirements
Stakeholder management
Customer service
Good Microsoft Excel skills and math aptitude
Delivering results and meeting customer expectations
Interpersonal skills
Planning and organizing
Presenting and communicating information
Persuading and influencing
Supervisory skills.
Adhering to principles and values.

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