Jobs
>
Nairobi

    Senior Medical Claims Assessor – Inpatient Claims at - Nairobi, Kenya - Jubilee Insurance

    Jubilee Insurance
    Jubilee Insurance Nairobi, Kenya

    15 hours ago

    Default job background
    Full time
    Description
    Jubilee Insurance was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa in 1937.

    Jubilee Insurance has spread its sphere of influence throughout the region to become the largest Composite insurer in East Africa, handling Life, Pensions, general and Medical insurance.

    Job Ref


    No:
    JHIL080
    Role Purpose

    The job holder will be responsible for ensuring efficient processing and assessment of inpatient medical claims within the organization and ensuring accurate assessment and processing of medical claims, ensuring fair and efficient reimbursement while maintaining compliance with regulatory guidelines and adhering to company policies.

    Main Responsibilities

    Strategy

    Support the development and implementation strategies to optimize the claims assessment process and enhance efficiency.
    Identify areas for process improvement and make recommendations for streamlining workflows.
    Stay updated with industry trends and changes in healthcare regulations to ensure compliance and mitigate risks.

    Operational

    Review and assess medical claims, verifying the accuracy of information provided.
    Apply knowledge of medical procedures, diagnoses, and coding systems to determine the validity and eligibility of claims.
    Evaluate medical records, invoices, and other relevant documentation to determine the appropriateness of reimbursement.
    Communicate with healthcare providers, policyholders, and internal teams to gather additional information or clarify claim details.
    Adhere to predefined timelines and service level agreements for claims assessment and resolution.
    Collaborate with internal teams such as underwriting, finance, and customer service to address claim-related queries and issues.

    Requirements
    Corporate Governance

    Ensure compliance with company policies, procedures, and regulatory guidelines.
    Maintain confidentiality and handle sensitive information in accordance with data privacy laws and regulations.
    Adhere to ethical standards and maintain professional conduct while dealing with confidential or sensitive matters.

    Key Competencies

    In-depth knowledge of medical terminology, healthcare procedures, and coding systems.
    Strong analytical and problem-solving skills.
    Attention to detail and ability to maintain accuracy while processing complex information.
    Excellent communication and interpersonal skills.
    Ability to work independently and manage time effectively.
    Critical thinking and decision-making abilities.
    Knowledge of insurance industry practices and claim adjudication processes.
    Adaptability and flexibility to handle changing priorities and work in a fast-paced environment.

    Qualifications

    Bachelor's degree in a business, insurance or clinical related field
    Good understanding of the concepts of medical insurance
    Proficient in the use of Microsoft office suite and packages
    Proficient in use of Actisure system

    Relevant Experience

    Minimum of 4 years' experience in a similar role.
  • Britam

    EMC Medical Claims Assistant at

    5 days ago

    Britam Nairobi, Kenya Full time

    Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi. · Job Purpose: · Con ...

  • Britam

    EMC Case Management Assistant at

    2 days ago

    Britam Nairobi, Kenya Full time

    Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi. · Job Purpose: · Con ...

  • Britam

    Claims Analyst at

    5 days ago

    Britam Nairobi, Kenya Full time

    Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi · Job Purpose: · Repo ...

  • Britam

    Case Management Officer

    4 days ago

    Britam Nairobi, Kenya Full time

    ABOUT THE COMPANY · Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi. ...

  • Jubilee Insurance KE

    Investment & Relationship Officer

    1 week ago

    Jubilee Insurance KE Nairobi, Kenya Full time

    ABOUT THE COMPANY · Jubilee Insurance was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa in 1937. Jubilee Insurance has spread its sphere of influence throughout the region to become the largest Composite insurer in East Africa, h ...

  • Aga Khan Hospitals

    Patient Services Coordinator, Credit Control, Finance Division

    3 days ago

    Aga Khan Hospitals Nairobi, Kenya Full time

    JOB SUMMARY · Requirements · A minimum of a Diploma in Business Administration/Credit Management, Public Relations, Front Office Service or equivalent · CPA Part II. · A minimum of 6 months' experience in a busy Credit Control environment preferably in a hospital setting. · Expe ...

  • Zamara Kenya

    Assistant Consultant, Care Management at

    1 week ago

    Zamara Kenya Nairobi, Kenya Full time

    Zamara is a financial services firm that primarily offers Actuarial Services, Pensions Administration and Consulting and Insurance Brokerage Services. Zamara has been in the Kenyan Market for over 23 years, initially operating as Hymans Robertson and more recently as Alexander Fo ...

  • Halisi Family Hospital

    Client Services and Health Records Officer at

    6 days ago

    Halisi Family Hospital Nairobi, Kenya Full time

    Halisi Family Hospital is a multi-specialty 25-bed inpatient and outpatient hospital in Kitengela, Kajiado county. · Role Summary · The role holder ensures client satisfaction by coordinating and facilitating the smooth flow of patients, visitors, and information within the frame ...