Assistant Manager Health Claims

Job Detail

Job ID 9573
Offered Salary 1000
Career Level Executive
Experience 6 Years
Gender Both
Industry Insurance
Qualifications Diploma
Location Nairobi

Job Description

Assistant Manager Health Claims

Primary Location

: Kenya-Nairobi-Nairobi

Organization

: Britam

Job Type

: Permanent

Shift

: Day Job

Contract Type

: Full-time

Job Posting

: 22-01-2025

Unposting Date: 29-01-2025

Number of Openings

: 1

Job Description

Assistant Manager Health Claims – (2500000C)

Job Purpose and Key responsibilities

Job Purpose:

Overall managing medical claims processes and procedures through the use of effective techniques to achieve the objectives of claims cost control and operational efficiency.

Key responsibilities:Assistant Manager Health Claims

Oversee the claims process flows to ensure efficiency in processing of claims as per the company medical claims procedure manuals.
Verification and audit of outpatient and inpatient claims as per the claims manual and customer service charter manual to ensure compliance and mitigate risk.
Oversee processing and settlement of medical claims.
Hold regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs.
Prepare scheme by scheme and portfolio performance reports.
Quality Assurance, develop review and implement quality assurance principle for Inpatient and Outpatient claims.
Oversee automation of all claims processes and use of AI and Machine learning.
Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers.
Supervise; train and mentor medical claims staff to achieve a high level of motivation and productivity by the team.
Prepare regular claims reports to clients, management and advice medical underwriting section on relevant claims findings for medical risk review.
Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, experience and qualifications required

Knowledge, experience and qualifications required:Assistant Manager Health Claims

Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
Professional qualification in Insurance (ACII, FLMI or IIK).
6-8 years’ experience in medical claims handling two of which should be in a supervisory position in a busy insurance office.
Knowledge of insurance concepts.

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Assistant Manager Health Claims

Job Detail

Job Description

Assistant Manager Health Claims

Primary Location

Organization

Job Type

Shift

Contract Type

Job Posting

Unposting Date: 29-01-2025

Number of Openings

Other jobs you may like

Business Development Manager job at KCB Bank

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