Claims Analyst at Old Mutual Kenya

Job Description

To process medical claims with a focus on control and management of member benefits through vetting and coding of inpatient and outpatient bills and capturing in the company medical business operating system(s).

• Verify audit and capture outpatient and inpatient claims as per the claims manual and customer service charter manual to ensure compliance to agreed turnaround times and mitigate risk.
• Negotiate professional fees including discounts to control expenditure.
• Hold regular business meetings with service providers to ensure compliance on systems such smart card system and agreed tariffs.
• Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes.
• Pre-authorize relevant outpatient services and generate monthly reports and recommendations on performance patterns.
• Assist in case management activities.
• Any other duties assigned by management.

Skills

• Auditing, Case Management, Medical Claims, Vetting

Education

• Bachelor of Science in Nursing (BScN)  (Required)

Closing Date

26 February 2022