Junior Claims Assessor

About the role

Stratostaff East Africa is recruiting a Junior Claims Assessor in Nairobi for its client in the insurance sector. The role supports existing and potential customers by assessing claims and cases, checking them against project objectives and payer expectations, and keeping the provider team informed.

Key responsibilities

• Verify and analyse all data on claims and cases, and report simple but detailed feedback to the provider team when they do not meet project expectations.
• Report general trends or inconsistencies found during assessment to the operations and provider teams.
• Assess claims and cases submitted by providers in a timely way, understand the queries raised and follow up until they are resolved.
• Support the customer call centre in addressing medical queries escalated to the client.
• Document and extract, present or discuss provider practices and disease trends, and deliver feedback and training to address them.
• Map generic rules to medical services, procedures, drugs and lab tests.
• Take part in testing and documentation of selected client systems.
• Perform other duties assigned by the supervisor.

Required profile

• Degree or diploma in clinical medicine or nursing.
• Good understanding of private and public healthcare delivery.
• Strong understanding of medical treatment protocols and cost-effective prescribing habits in relation to market segmentation.
• At least 2 years' experience in a busy hospital setting; insurance experience is an added advantage.

Required skills

• Data entry with accurate work.
• Reporting and attention to detail.
• Ability to prioritise and meet deadlines.
• Good analytical, problem-solving, oral and written communication, and interpersonal skills.
• Teamwork, customer service and confidentiality.