Claims Analyst/Vetting Officer – Medical at CIC Insurance

PURPOSE:

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

PRIMARY RESPONSIBILITIES:

• Vet and audit inpatient and outpatient medical bills/invoices in order to pay service providers promptly.
• Process reimbursement claims within the stipulated TAT.
• 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 stakeholder queries and complaints promptly and professionally
• Recommend risk improvement measures to the underwriter to take appropriate action.
• Fraud detention within claims function and escalation of any suspicious claims to the supervisor

Academic and Professional Requirements

Education 

• Minimum of a Diploma in Nursing (KRCHN)  
• Computer literate in MS Office and other office applications  

Experience Required:

• Relevant experience    3