Claims Payment Integrity Consultant

16 hours ago

Nairobi, Nairobi Area, Kenya Bupa 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 happen
At Bupa, we're here to help people live longer, healthier, happier lives and make a better world. As a
Claims Payment Integrity Consultant
, 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 purpose.

How You'll Help Us Make Health Happen

  • Review and approve new bank account details before claims are paid
  • Validate provider information for new and existing providers not yet stored in our systems
  • Add verified providers to our SWAN system with complete and accurate contact details
  • Investigate out-of-network providers flagged by claims rules
  • Refer suspicious providers to our Counter Fraud Team and reject unverifiable claims
  • Respond to customer queries and additional information related to claims
  • Identify and escalate potential fraudulent behaviour by members or providers
  • Support cost containment by following claims guidelines and rules
  • Collaborate with internal stakeholders, including Claims Fraud Validation Officers
  • Maintain accurate customer records and ensure updates are made promptly
  • Comply with regulatory standards including Financial Regulatory Authority (FRA), Insurance Regulatory Authority (IRA) and Treating Customers Fairly
  • Meet service level agreements and quality standards
  • Support new team members and contribute to continuous improvement
  • Be a role model for Bupa's values and behaviours

Key Skills/qualifications Required For This Role

  • Previous experience in medical claims is essential
  • Medical background would be beneficial
  • Strong written and spoken English; multilingual skills are a plus
  • Excellent problem-solving and prioritisation skills
  • High attention to detail and strong numerical ability
  • Comfortable working independently and as part of a team
  • Understanding of regulatory environments and customer fairness principles
  • Ethical, honest, and resilient with a commitment to doing what's right
  • Confident in managing risk and contributing to a compliant, trustworthy claims process

Time Type
Full time

Job Area
Locations:

Kenya - Nairobi

  • Claims Payment Integrity Consultant

    16 hours ago

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

    Job DescriptionClaims Payment Integrity ConsultantNairobi, KenyaFull timePermanentAdvert closes Friday 3rd October 2025We make health happenAt Bupa, we're here to help people live longer, healthier, happier lives and make a better world. As aClaims Payment Integrity Consultant, you'll play a vital role in protecting the integrity of our claims process....

  • Claims Representative

    2 weeks ago

    Nairobi, Nairobi Area, Kenya The Cigna Group Full time 900,000 - 1,200,000 per year

    The job profile for this position is Claims Representative, which is a Band 1 Professional Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we...

  • Claims Representative

    2 weeks ago

    Nairobi, Nairobi Area, Kenya The Cigna Group Full time $40,000 - $60,000 per year

    We are looking for a detail-oriented claims Representative to join our claims team. You will be responsible for verifying information and corresponding with agents and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.To be successful as a claim's processor, you should...

  • Claims Representative

    2 weeks ago

    Nairobi, Nairobi Area, Kenya Cigna Healthcare Full time $40,000 - $60,000 per year

    We are looking for a detail-oriented claims Representative to join our claims team. You will be responsible for verifying information and corresponding with agents and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.To be successful as a claim's processor, you should...

  • Benefits Payment Analyst

    2 weeks ago

    Nairobi, Nairobi Area, Kenya CIC Insurance Full time 900,000 - 1,200,000 per year

    PURPOSE:PRIMARY RESPONSIBILITIES:Register, analyze and process all reported uncertain claims and advice clients on the required claims supporting documents Verify and authorize processed claims up to specified limits; Resolve customer complaints and disputes swiftly, fairly and diplomatically; Analyze policies due for certain claims and process the claims...

  • ERP Integrations Consultant

    2 weeks ago

    Nairobi, Nairobi Area, Kenya Solutech Limited Full time $50,000 - $100,000 per year

    Solutech Limited is seeking to engage highly skilled and experienced consultants for the following roles: ERP Integrations Consultant The responsibility is to design, develop, and deploy a comprehensive, AI-powered data reporting system. Solutech aims to design and implement a Data Management System to bridge the challenge of a lack of...

  • Claims Manager-Nairobi HQ

    3 days ago

    Nairobi, Nairobi Area, Kenya Waumini Insurance brokers Limited Full time $104,000 - $130,878 per year

    Company:Waumini Insurance Brokers Ltd.Location:Waumini House, WestlandsAbout Us:We are a leading insurance broking firm committed to delivering exceptional customer service and tailored risk solutions to our clients. We pride ourselves on professionalism, integrity, and excellence. To strengthen our team, we are seeking an experienced and...

  • Payment Methods Operations Specialist

    2 weeks ago

    Nairobi, Nairobi Area, Kenya Sportserve Full time $40,000 - $80,000 per year

    Sportserve forms part of a remarkable group of B2C sports betting and B2B sportsbook technology companies, focused on delivering first class sports betting experiences and casino products for our users worldwide. Along with Sportion, TechSpirit, Standard Focus and Sportelligent, we are the driving force behind the world renowned sports betting company and...

  • Pastoral Private Sector Market Integration Expert Consultant

    2 weeks ago

    Nairobi, Nairobi Area, Kenya ReliefWeb Full time $50,000 - $100,000 per year

    KenyaPastoral Private Sector Market Integration Expert ConsultantOrganizationAfrican Union - InterAfrican Bureau for Animal ResourcesPosted 2 Sep 2025 Closing date 29 Sep 2025Introduction and ContextThe African Union Inter-African Bureau for Animal Resources (AU-IBAR) is a specialized technical office of the Department Agriculture, Rural Development, Blue...

  • Senior Billing Consultant

    2 weeks ago

    Nairobi, Nairobi Area, Kenya SWATX Full time $90,000 - $120,000 per year

    Job SummaryWe are looking for a Senior Microsoft Dynamics 365 Billing Consultant to design, implement, and optimize billing and invoicing solutions using Microsoft Dynamics 365 Finance & Operations (F&O) and Customer Engagement (CE). The ideal candidate will have deep expertise in billing, invoicing, subscription management, and financial transactions within...