Claims Payment Integrity Consultant

5 days 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

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