Senior Medical Claims Assessor – Inpatient Claims at

1 month 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
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.

Requirements
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.

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.

  • Nairobi, Nairobi Area, Kenya Britam Full time

    Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi.Job Purpose:Controlling and Managing policies through case management to ensure quality and cost...

  • Claims Analyst at

    1 month ago


    Nairobi, Nairobi Area, Kenya Britam Full time

    Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and MalawiJob Purpose:Reporting to the Claims Manager, the incumbent will be responsible for customer...


  • Nairobi, Nairobi Area, Kenya Kenbright Holdings Full time

    Kenbright has developed unparalleled business intelligence tools based on our actuarial and risk management consulting arm to help our clients live their lives with confidence, to give them peace of mind, and enable them to realize their dreams for their loved ones and their legacy.Duties. Confirming eligibility cover. Review and process medical insurance...


  • Nairobi, Nairobi Area, Kenya Cigna Full time

    Cigna is a global health service company, dedicated to helping the people we serve improve their health, well-being and sense of security. Cigna has almost 40,000 employees who service over 80 million customer relationships around the world.Main Duties / Responsibilities A medical claims processor validates the information on all medical claims from patients...


  • Nairobi, Nairobi Area, Kenya Cigna Full time

    Cigna is a global health service company, dedicated to improving the health and well-being of the people they serve. With nearly 40,000 employees catering to over 80 million customer relationships worldwide. YOUR ROLE Execute basic technical, administrative, or operational Claims tasks. Process paper and/or electronic claims from Healthcare Providers. ...


  • Nairobi, Nairobi Area, Kenya Britam Full time

    Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi.Job Purpose:To effectively process medical claims by verifying and updating information about...

  • Claims Assistant at

    3 weeks ago


    Nairobi, Nairobi Area, Kenya Incourage Full time

    Simplifying insurance access and distribution for insurance agencies.About the Claims Assistant Role This role involves filing and processing claims into the company's system, gathering and organizing files for audits and corresponding with insured individuals about obtaining the information necessary to file claims correctly. The job holder is expected to...

  • Claims Assistant

    3 weeks ago


    Nairobi, Nairobi Area, Kenya Incourage Full time

    ABOUT THE COMPANYTo encourage and increase the players in the insurance industry by building a No.1 platform where anyone can easily purchase and sell insurance products in Africa. JOB SUMMARYThis role involves filing and processing claims into the company's system, gathering and organizing files for audits and corresponding with insured individuals about...

  • Claims Officer at

    2 weeks ago


    Nairobi, Nairobi Area, Kenya Kenya Airways Full time

    Kenya Airways, the leading African airline flying to more African destinations than any other carrier, takes pride in being at the forefront of connecting Africa to the world and the World to Africa through its hub Nairobi Jomo Kenyatta International Airport.SummaryThe candidate will enhance customer service standards and portray positive company image by...

  • Claims Officer

    1 week ago


    Nairobi, Nairobi Area, Kenya Kenya Airways Full time

    ABOUT THE COMPANYKenya Airways is the Africa's Leading Airline-Business in the World.JOB SUMMARYQualification (Minimum) Bachelor's degree in business or related field.Computer skills and knowledge in Microsoft office.Part qualification ACII / Diploma in Insurance.Interpretation and application of conditions carriage for Baggage & Cargo.3 years' experience in...

  • Claims Manager at

    3 weeks ago


    Nairobi, Nairobi Area, Kenya Capex Life Assurance Kenya Full time

    Founded in 2000 with headquarters in Lagos, Nigeria, Capital Express Assurance has grown over the years to become one of the biggest life insurers in West Africa and has made the extra step to add Eastern Africa region to its global footprint. Operating as Capex Life Assurance in Kenya, we operate as a specialist life insurance company, with our major...

  • Claims Intern

    1 week ago


    Nairobi, Nairobi Area, Kenya Absa Group Ltd Full time

    JOB SUMMARYJob DescriptionEnsure that the allocated claims processes are performed within the time frames as agreed with clients, brokers, and other departments to ensure service delivery.Ensure that service providers fee notes, invoices and Discharge vouchers are settled within the set TATs.Review the performance of the service provider semiannually and...


  • Nairobi, Nairobi Area, Kenya Madison Group Limited Full time

    Madison Group Limited is a locally owned financial services holding company that specializes in Insurance and wealth management services. The Group comprises of Madison Life Assurance Kenya Limited, Madison General Insurance Kenya Limited, and Madison Investment Managers Limited. Madison Life Assurance Kenya was originally incorporated under Kenyan Laws in...


  • Nairobi, Nairobi Area, Kenya Trident Insurance Company Full time

    Trident Insurance Company Limited is incorporated in Kenya and licensed to transact General Insurance business. It was licensed and began full operations in 1982. Trident Insurance has a team of highly qualified, dynamic and experienced staff who offer professional and personalized insurance services efficiently.SummaryJOB REF TICL/002/2024 Job...


  • Nairobi, Nairobi Area, Kenya CIC Insurance Full time

    CIC Insurance Group Limited, commonly referred to as CIC Group, is an insurance and investment group that operates mainly in Kenya, Uganda, South Sudan and MalawiPURPOSE:Responsible for effectively handling claims and settling them within stipulated timelines.PRIMARY RESPONSIBILITIES:Register and analyse intimated claims and advise client on supporting...


  • Nairobi, Nairobi Area, Kenya Nairobi Adventist Hospital Full time

    ABOUT THE COMPANYNairobi Adventist hospital, a new level 4 Faith Based Hospital provides excellent employmentopportunities to competent, diligent and ethical individuals. We are located in Nyari, Westlandsoff Redhill Road.JOB SUMMARYQualificationsDegree or Diploma in Business Administration, Economics, Finance or other business-related fields from a...


  • Nairobi, Nairobi Area, Kenya Nairobi Adventist Hospital Full time

    Nairobi Adventist Hospital (NAH) is a Seventh-day Adventist (SDA) church-established and owned Hospital. It is a tertiary (level 4) hospital located in Nyari west area in Westlands sub-county, Nairobi County, Kenya.Job PurposeThe main purpose of the job is to provide correct billing for patients under cash, insurance and NHIF cover in an accurate and timely...


  • Nairobi, Nairobi Area, Kenya Britam Full time

    Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi.Job Purpose:Controlling and Managing policies through case management to ensure quality and cost...


  • Nairobi, Nairobi Area, Kenya Britam Full time

    ABOUT THE COMPANYBritam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi. The group offers a wide range of financial products and services in Insurance,...


  • Nairobi, Nairobi Area, Kenya Jubilee Insurance KE Full time

    ABOUT THE COMPANYJubilee 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. Today, Jubilee is the number...