Deputy Head of Medical at MUA Kenya

Applications are invited from appropriately qualified candidates for the position of Deputy Head of Medical in the Medical Department.

 Position Summary:

The successful candidate will be responsible for provider management by reconciling accounts with medical service providers and advising them on valid members and facilitates closure of the medical accounts to maintain the company’s credit worthiness. Excess and Fund Management, reporting and ensuring compliance

Key Deliverables:

• Reconciling accounts (claims received versus payments) to 100% within 3 months after the end of the contract year.
• Facilitating annual provider accounts sign off and recording keeping of the same
• Negotiate for discounts from providers
• Maintaining the system updates for; discounts, claims write offs, new providers additions
• Set up and maintain criteria of appointment and maintenance of new providers
• Ensure resolution of membership queries that affect reconciliations
• Assisting in conducting provider audits and quality assurance wherever necessary
• Obtaining additional required information on claims from providers, brokers or clients as part of debt management and reconciliation
• Following up on provider payments to ensure they are made on time
• Ensure effective dispatch of cheques and payments to the service providers and members across the country.
• Advising management on any peculiarities noted in the claims from group providers
• Facilitating the return of claims inadequately documented, claims for which members are not covered after verifying with the underwriter, non-payable claims and inadmissible bills.
• Manage medical excesses and collection to ensure minimal liability to the company
• Provide monthly updates on excess management
• Ensure effective system set up and management of third-party funds
• Assisting the credit control team in conducting reconciliation on Third party scheme accounts to ensure balances are accurate.
• Ensuring that management of Third-Party schemes is done ensuring that they are sufficiently funded to allow for services to be provided to clients.
• Follow up on collection, receipting and record keeping on Third party schemes.
• Reporting and analysis of the financial aspect of the medical business
• Assist the Head of Medical in overseeing the operations of the medical department to ensure effective running of the department
• Ensure regulatory reports are submitted.
• Staff management and monitoring on issues of leave, appraisals, training and day to day work duties.

Requirements:

Applicant should have:

1. Bachelor of Commerce
2. Qualification or progress towards achievement of CPA K certification
3. At least 4 years’ experience in the insurance sector