Provider Reconciliation Officer

About the role

A third-party administrator (TPA) in Nairobi is hiring a full-time, on-site Provider Reconciliation Officer. The role ensures accurate reconciliation of healthcare providers' accounts by validating claims, invoices, payments, recoveries, credit notes and provider statements, and acts as a key liaison between providers, claims teams, medical teams, finance teams and clients. The employer is listed as Afia Concept Claims Settling Agency.

Key responsibilities

• Reconcile provider statements against adjudicated claims and payment records, verify invoices, statements and account balances, and investigate discrepancies such as overpayments, underpayments and duplicate payments.
• Validate claims before payment, reconcile them against contractual payment schedules and tariffs, and review rejected or partially settled claims.
• Respond to provider queries about invoices, payments and deductions, investigate disputes and follow up on open issues until closed.
• Monitor ageing balances, support recovery of overpayments and help prevent billing irregularities and fraudulent claims.
• Maintain professional relationships with providers, attend provider engagement meetings and promote payment transparency.
• Prepare daily, weekly and monthly reconciliation reports, exception reports and records, and support month-end and year-end reporting.
• Identify gaps in reconciliation processes, recommend improvements and support new controls and tools.
• Ensure compliance with policies, contracts and regulatory requirements, maintain confidentiality and support audits.

Required profile

• Bachelor's degree in Accounting, Finance, Business Administration, Economics, Insurance, Health Records, Healthcare Management or a related field.
• At least 2 years' experience in healthcare finance, claims management, provider reconciliation, medical insurance, managed care or a related field; TPA, health insurer or managed care experience preferred.
• Diploma or degree in Accounting, Finance or a related field mentioned in the summary.

Required skills

• Proficiency in Microsoft Excel and reconciliation systems.
• Strong analytical skills, attention to detail and knowledge of healthcare claims processing and provider payment cycles.

The position is full time and on site in Nairobi, with an application deadline of 05/11/2026. Candidates apply through the recruitment agency's online application form.