Claims Adjudicator at Resolution Insurance

Key Responsibility Areas of the Claims Adjudicator:

• Analyze claims in details for processing.
• Accurately vet and code valid claims for payment.
• Resolve and reconcile problems related to claims, by liaising with the providers and other relevant
  stakeholders.
• Identify and prevent fraud instances in the claims process.
• Achieve daily targets as stipulated in the claims policy.
• Maintain the claims timelines as stipulated in the claims policy.
• Timely processing of the claims within the approved matrix levels.
• Timely clearance of all claims batches as stipulated in the claims policy.
• Escalation of non-resolved issues to MSP relations within 7 days of initial contact with MSP.
• Prepare the relevant departmental reports.
• Communicate with clients or MSPs regarding claims.

Qualifications Required For The Claims Adjudicator Job:

Essential

• Diploma in a clinical medicine or Nursing.
• KRCHN or KRN/M Certification.
• At least 3 years relevant experience in health management.

Desirable

• In-depth knowledge of health management
• Computer skills including knowledge of Microsoft Office.