Our Kenyan Client, a leading insurance and financial services company in East Africa seeks to recruit a Deputy Medical Claims Manager. (S)He will be reporting to the Medical Claims Manager.
To control and manage medical claims processes & procedures through the use of effective techniques to achieve the objectives of claims cost control, operational efficiency and meeting of the
customer service charter in claims payment.
* Oversight of 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.
* Negotiate professional fees and hospital charges including discounts to control expenditure.
* Oversee processing, settlement of all claims and authorize requisitions.
* Holding regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs.
* 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 underwriter health on relevant claims findings for medical risk review.
* Diploma or Degree in Nursing
* Diploma in Insurance and or a degree in Health systems Management/ Business management will be an added advantage
* 2 years experience in clinical setting
* At least 3 years of experience working as a claims team leader in a busy insurance environment
* Excellent communication and negotiation skills.
* Excellent public relations and interpersonal relationship skills.
* Extensive networking with SP and other medical insurers
* Excellent analytical and monitoring skills
* User IT skills in database management and office systems.
* Ability to evaluate decisions made in benefit utilization management.
* Integrity and honesty
How to Apply:
If you are qualified and up to the challenge, please send applications to firstname.lastname@example.org, indicating on the subject line the role title.
Please note that only qualified candidates will be contacted.
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