Claims Officer at International Rescue Committee

• The SHIF Claims Officer at IRC Kenya plays a pivotal role in managing and overseeing the processing, documentation, and submission of claims to the Social Health Insurance Fund. The incumbent will ensure accurate and timely processing of claims, adherence to SHIF guidelines, and effective communication with stakeholders to facilitate reimbursement and improve healthcare service delivery.

Key Responsibilities:

Claims Processing:

• Manage the end-to-end process of SHIF claims, ensuring accuracy and completeness of documentation.
• Review and verify claim forms and supporting documents submitted by healthcare facilities or beneficiaries.
• Input and maintain accurate data related to claims in the designated systems or databases.
• Continuous follow up the claims submitted to SHIF to ensure timely reimbursement of the claims.

SHIF Guidelines Adherence:

• Stay updated with SHIF policies, regulations, and guidelines to ensure compliance in claims processing.
• Interpret and apply SHIF rules appropriately while processing claims to prevent discrepancies or rejections.

Documentation and Record-Keeping:

• Maintain organized and comprehensive records of all claim-related documents, ensuring confidentiality and accessibility as per organizational policies.
• The claim officer will be required to provide the finance department with accurate information regarding the claims submitted to SHIF for reimbursement to be captured into the financial system.
• Prepare accurate reconciliation of claims report against the funds received bi-weekly and submit to Finance Officer for review. Ensure that all outstanding claims/discrepancies are followed and settled immediately.
• Continuous liaison with Finance department for confirmation of receipt of funds from SHIF to enable you perform the reconciliation report.
• Generate and prepare reports on claim processing activities for internal audits or reporting purposes.

Communication and Coordination:

• Liaise with healthcare providers, beneficiaries, and SHIF representatives to resolve any claim-related queries or discrepancies.
• Collaborate with internal teams such as finance, administration, and program staff to facilitate seamless claim processing.

Quality Assurance:

• Conduct regular audits on processed claims to ensure accuracy, compliance, and alignment with SHIF regulations.
• Identify areas for process improvement and contribute to the development of streamlined claim processing procedures.

Minimum Qualifications:

• Bachelor’s degree in Business Administration or Accounting, or related field and 2 years’ experience in claims processing or Diploma in either accounting or business administration with 5 years of experience in processing claims.
• In-depth knowledge of SHIF policies, procedures, and regulations.
• Strong analytical skills with attention to detail and accuracy in documentation.
• Proficiency in using relevant software and databases for claims processing.
• Excellent communication skills (verbal and written) with the ability to interact effectively with diverse stakeholders.
• Ability to work independently, manage multiple tasks, and meet deadlines in a fast-paced environment.
• Commitment to maintaining confidentiality and upholding ethical standards in healthcare operations.

Additional Information:

• This position may require occasional travel to field locations or healthcare facilities.
• Fluency in English (written and spoken) is required.