Assistant Medical Claims Analyst at PACIS Insurance

PACIS Insurance Company Limited is a financial institution regulated by IRA which has been in operations for over 15 years in the Kenyan market. The company is an initiative of the Catholic Church which offers a wide range of insurance products within the General and Medical Insurance classes. To meet its growing customer needs and expectations, the company wishes to recruit an experienced, dynamic, and innovative Assistant Medical Claims Analyst.

PURPOSE OF THE JOB

• To evaluate medical claims submitted to the company and determine whether claims meet eligibility standard of the company.
• Reconcile provider statements and schedule their payments

PRINCIPAL ACCOUNTABILITIES

Claims Processing

• Receiving invoices form various service providers and registering them into system.
• Verifying and auditing all medical claims to ensure supporting documents are attached and following up of documents not submitted with service providers/clients.
• Accurate capturing all invoices in the system.
• Indexing of payment vouchers in the system

Provider Management

• Prompt account reconciliation and sign offs with provider and address all disputes to completion.
• Recommend appropriate payment of disputed billing as necessary
• Negotiate and schedule monthly medical payments.
• Prepare and send payment remittances
• Prepares monthly claims, reconciliation and sign off reports for the management

Customer Service

• Respond to client’s queries on telephone, calls, emails and walk in clients.
• Build and enhance relationship with providers to ensure Pacis Insurance account with the providers is active.
• Ensure adherence to contracts and service level agreements between providers and the company.

KNOWLEDGE, SKILLS AND EXPERIENCE:

Minimum Academic Qualifications

• Degree in Business related course / Actuarial/ Statistics/ Social

Professional Qualifications

• Diploma in Insurance IIK

Experience

• Minimum 2 years’ experience in the claims section of a health insurance company

Knowledge

• Understanding of insurance industry

Skills and Competencies

• Interpersonal and Communication skills
• Integrity
• Analytical skills
• Decision making
• Stakeholder management
• Negotiation
• Financial Awareness
• Planning and organization skills
• Keen to detail