Ciala Hospital Claims Officer Jobs in Kenya

Ciala Hospital Claims Officer Jobs in Kenya; The Claims Officer will be responsible for processing, submitting, and reconciling insurance claims, ensuring compliance with SHA and private insurer requirements, and supporting hospital revenue cycle efficiency.

Qualifications & Requirements

Diploma or Degree in Clinical Medicine, Business Administration, Health Records, Finance, or any other relevant business/health‑related field.

Minimum of three (3) years’ relevant experience in a busy private hospital setting.

Strong and proven knowledge of SHA (Social Health Authority) claims processes and other private insurance schemes.

Good understanding of hospital billing, pre‑authorizations, claim submissions, and reconciliation processes.

Experience in handling claim rejections, resubmissions, and follow‑ups with insurers.

Familiarity with hospital management systems and electronic claims processing will be an added advantage.

Strong analytical, numerical, and documentation skills.

High level of accuracy, integrity, and attention to detail.

Excellent communication and follow‑up skills with insurers and internal hospital departments.

Ability to work effectively under pressure in a fast‑paced environment with strict deadlines.

Key Responsibilities

Process and submit insurance claims accurately and in a timely manner in line with SHA and private insurer requirements.

Review patient documentation to ensure completeness and compliance before claim submission.

Follow up on pending, rejected, or queried claims with insurance providers.

Conduct claim reconciliation and assist in resolving variances between billed and paid amounts.

Ensure proper coding and documentation support for all submitted claims.

Collaborate closely with clinicians, billing, and finance teams to ensure accurate claim preparation.

Maintain organized records of all claims submitted, paid, pending, or rejected.

Support pre‑authorization processes and verification of patient eligibility where required.

Monitor claim performance and provide regular reports on claim status and trends.

Ensure compliance with insurance policies, hospital procedures, and regulatory requirements.

How to Apply

Interested and qualified candidates should forward their CV to: careers@cialahospital.com using the position as subject of email.

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