Claims Analyst - Medical Claims

About the role

A leading financial and health insurance company, recruited through Stratostaff East Africa, is looking for a Claims Analyst based in Nairobi. The role centres on processing medical claims with a focus on accuracy, cost containment, risk management and customer excellence.

Key responsibilities

• Review, assess, authenticate and capture outpatient and inpatient claims according to the claims manual and within the set turnaround times (TATs).
• Scan, barcode and batch received claims timely, and process reimbursements within the set TATs.
• Run a quality assurance check before batches are authorised for payment.
• Notify brokers and clients of pended and declined claims within set timelines, manage those claims and liaise with agents, brokers and service providers.
• Archive all claims documents in the relevant systems and maintain claims production within targets.
• Generate a daily health claims status report and store all correspondence in the Medware system.
• Monitor and process NHIF enhanced benefits for cost containment, and record and monitor roaming and counter-guarantee claims.
• Handle client queries by telephone, letter, email and walk-in, and uphold department standards, discipline and patient confidentiality.

Required profile

• Bachelor's degree or diploma in a medical, insurance or business-related discipline; progress towards a Diploma in Insurance is an added advantage.
• 1 year of experience in medical claims management in an insurance or hospital setting.

Required skills

• Knowledge of insurance concepts, medical claims processes and procurement, and insurance regulatory requirements.
• Good Microsoft Excel skills and math aptitude.
• Customer service, stakeholder management, planning and organising, and interpersonal and supervisory skills.