Claims Officer

7 days ago


Nairobi, Nairobi Area, Kenya Aga Khan Hospital Kisumu Full time
Medical Claims Specialist

The Aga Khan Hospital in Kisumu is a leading healthcare provider in the region, and we are seeking a highly skilled Medical Claims Specialist to join our team.

Job Summary

The successful candidate will be responsible for verifying and processing medical claims, ensuring that all corporate clients' claims are settled in a timely and accurate manner.

Key Responsibilities
  • Verify and vet medical claims for both outpatient and inpatient claims, adhering to the claims manual and standard operating procedure.
  • Adhere to customer service charter manual to ensure compliance with agreed turnaround times.
  • Promptly report any identified risks during claims processing for mitigation.
  • Evaluate preliminary claim information and revert to corporate clients for additional information where necessary.
  • Monitor invoices returns and take appropriate action within a week from the date of return on clinical issues and any query.
  • Take the lead in ensuring reasons for returns are well addressed to avoid future recurrence.
  • Prepare rejection analysis on clinical issues and monthly reports to guide the institution on the status of control.
  • Work with dispatch section to ensure all invoices have been dispatched after verification.
  • Work with debtors team to review all clinical issues within the reconciliation for signoff for the agreed period with corporate clients.
  • Filing of claim forms for diagnosis on reconciliations and maintaining accurate departmental reports on clinical issues.
  • Facilitate closures to all rejected invoices on medical issues.
  • Participate in all team efforts as departmental needs arise.
Requirements
  • Diploma or degree in nursing or equivalent.
  • Proficient in MS Office Suite.
  • Formal training in customer care or equivalent demonstrated experience.
  • A minimum of 3 years' experience in a busy hospital or insurance environment.


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