Wednesday, April 25, 2012

Deputy Medical Claims Manager Job in Kenya


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.

Main Purpose

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.

Responsibilities:
  • 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.
Qualifications:
  • Diploma or Degree in Nursing
  • Diploma in Insurance and or a degree in Health systems Management/ Business management will be an added advantage
Key Competencies:
  • 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 kenyanrecruiter@gmail.com, indicating on the subject line the role title.

Please note that only qualified candidates will be contacted.