Claims Vetting and Processing Officer at CIC Insurance

PURPOSE:

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

PRIMARY RESPONSIBILITIES:

• Vet in/outpatient medical bills/invoices and refer any suspicious claims to the supervisor;
• 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 customer queries and complaints promptly and professionally and
• Recommend risk improvement measures to the underwriter to take appropriate action.

PERSON SPECIFICATIONS

Academic Qualifications

• Bachelor’s degree in a related field or a Diploma in Nursing / Diploma in Clinical Medicine

Professional Qualifications

• Kenya Registered Nursing (KRN) Diploma – Required

Experience

• Up to three (3) years’ relevant experience

Skills and Attributes

• Problem solving skills;
• Good analytical skills;
• Computer literate in MS Office and other office applications;
• Understanding of the working environment /competitors;
• Technical competence in insurance;
• Basic knowledge of regulations by AKI and IRA;