CIC Insurance Claims Vetting and Processing Officer Jobs in Kenya

Purpose:

Responsible for vetting both in/ outpatient medical claims for payment.

Primary Responsibilities:

Vet in/outpatient medical bills/invoices and refer any suspicious claims to the supervisor;

Batch outpatient invoices on the system and adjust amount payable as per the vetting findings;

Check and reject incomplete invoices and return with supporting documents to service providers;

Negotiate, adjust and update service providers on their cost and accounts status;

Reconcile statements of accounts for service providers; advising accounts and service providers on unpaid/underpaid bills;

Review claims reserves on a continuous basis in view of new developments;

Attend to customer queries and complaints promptly and professionally and

Recommend risk improvement measures to the underwriter to take appropriate action.

Person Specifications

Academic Qualifications

Bachelor’s degree in a related field or a Diploma in Nursing / Diploma in Clinical Medicine

Professional Qualifications

Kenya Registered Nursing (KRN) Diploma – Required.

Experience

Up to three (3) years’ relevant experience.

Skills and Attributes

Problem solving skills;

Good analytical skills;

Computer literate in MS Office and other office applications;

Understanding of the working environment /competitors;

Technical competence in insurance;

Basic knowledge of regulations by AKI and IRA;

How to Apply

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