Claims Analyst at APA Life Assurance Company Ltd

Job description

To ensure prompt and fair settlement of all medical claims in accordance with the claims manual and guidelines in order to control claims expenditure and also maintain a good working relationship with service providers

KEY PRIMARY RESPONSIBILITIES

• Vetting and analyzing medical claims as per the scope of cover whilst ensuring strict adherence to set guidelines and TAT 
• Monitors service providers’ claims through analytics in view of ensuring they maintain high standards of service delivery 
• Reconciliation of medical providers’ bills & accounts on an ongoing basis or on-demand including visits to providers to sort out contentious bills/ issues 

ACADEMIC QUALIFICATIONS

• Diploma in Kenya Registered Community Health Nursing/ Clinical medicine/ pharmacy and/ or in any medical-related qualifications. 

JOB SKILLS AND REQUIREMENTS

• Computer literate and familiar with high processing speed using standard office software applications 
• Team player with strong interpersonal and persuasive skills 
• Good Communication and interpersonal skills
• Good analytical skills and keenness to details
• Excellent Negotiation skills
• Effective decision maker

PROFESSIONAL QUALIFICATIONS

• Certificate of Insurance Proficiency or any Insurance-related qualifications

EXPERIENCE

• At least 3 years’ experience in a busy health Insurance environment with a Claims Vetting & Care management background