Claims Payment Integrity Consultant

5 days ago

Nairobi, Nairobi Area, Kenya Bupa Global Full time 900,000 - 1,200,000 per year

Job Description

Claims Payment Integrity Consultant

Nairobi, Kenya

Full time

Permanent

Advert closes Friday 3rd October 2025

We make health happe

nAt Bupa, we're here to help people live longer, healthier, happier lives and make a better world. As a
Claims Payment Integrity Consultan
t, you'll play a vital role in protecting the integrity of our claims process. You'll help ensure that payments are accurate, legitimate, and made to the right people—supporting our mission to deliver trusted, high-quality healthcare

.

This role sits within Bupa Global, where we serve customers across the world. You'll be part of a team that's passionate about doing the right thing, reducing fraud, and making sure our members get the care they need. It's a role that combines attention to detail, investigative thinking, and a strong sense of purpos

**e.

How you'll help us make health hap**

  • penReview and approve new bank account details before claims are p
  • aidValidate provider information for new and existing providers not yet stored in our syst
  • emsAdd verified providers to our SWAN system with complete and accurate contact deta
  • ilsInvestigate out-of-network providers flagged by claims ru
  • lesRefer suspicious providers to our Counter Fraud Team and reject unverifiable cla
  • imsRespond to customer queries and additional information related to cla
  • imsIdentify and escalate potential fraudulent behaviour by members or provid
  • ersSupport cost containment by following claims guidelines and ru
  • lesCollaborate with internal stakeholders, including Claims Fraud Validation Offic
  • ersMaintain accurate customer records and ensure updates are made promp
  • tlyComply with regulatory standards including Financial Regulatory Authority (FRA), Insurance Regulatory Authority (IRA) and Treating Customers Fai
  • rlyMeet service level agreements and quality standa
  • rdsSupport new team members and contribute to continuous improvem
  • entBe a role model for Bupa's values and behavio

**urs

Key skills/qualifications required for this**

  • rolePrevious experience in medical claims is esse
  • ntialMedical background would be benef
  • icialStrong written and spoken English; multilingual skills are a
  • plusExcellent problem-solving and prioritisation s
  • killsHigh attention to detail and strong numerical ab
  • ilityComfortable working independently and as part of a
  • teamUnderstanding of regulatory environments and customer fairness princ
  • iplesEthical, honest, and resilient with a commitment to doing what's
  • rightConfident in managing risk and contributing to a compliant, trustworthy claims pr

ocess

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