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  • Posted: Mar 19, 2022
    Deadline: Mar 31, 2022
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    Apollo Group (Apollo Investments Limited)was an idea born from the need to harness synergies across the insurance business. Built on commitment, integrity and innovation, it has risen to be one of the leading financial groups in East Africa. Apollo Investments Limited (AIL) includes APA Insurance (Kenya and Uganda). It underwrites General Insurance risks ...
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    Claims Vetter

    The person will be responsible primarily for vetting medical claims for processing into the Health system, identify conditions, procedures and rejection that will facilitate fast processing of claims. Identify claims that do not meet the criteria of APA policy, procedures and medical norms. Responsible for ensuring quality and accuracy of claims processed while maintaining the TAT and production levels necessary for provider and Client satisfaction.

    KEY PRIMARY RESPONSIBILITIES

    • Coordination and adjudication of all claims received
    • Vetting of claims in line with APA policy, procedures, and benefits to ensure accuracy of processing and TAT
    • Processing of claims, as required, to ensure that production levels  and TAT are met
    • Negotiation where necessary of  professional fees and charges, including discounts, to control costs
    • Monitoring, preventing, and highlighting medical claims fraud through regular claim audits and reporting
    • Follow up with providers for bills, discrepancies in bills, and other information that is holding up processing
    • Answering client inquiries on claims through e-mail, phone, or directly
    • Reconciliation of provider accounts
    • Filing of Claims processed as required

    ACADEMIC QUALIFICATIONS

    • Degree holder and/or Diploma in Insurance, Health management , Nursing or other health-related fields

    JOB SKILLS AND REQUIREMENTS

    • Integrity and honesty
    • Able to manage tight deadlines
    • Attention to detail and to following processes
    • Excellent written and spoken communication skills
    • Skill in Computer use and reporting
    • Willingness to train and share knowledge with others
    • Willingness to work on weekends when required

    PROFESSIONAL QUALIFICATIONS

    • Relevant professional qualification

    EXPERIENCE

    • At least 1 year’s experience in Health claim processing in a busy environment and/or at least 1 year’s experience  in a medical field

    Method of Application

    Send mail to recruitment@apollo.co.ke indicating the position as subject of the mail

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