Medical Claims Vetter at Old Mutual Kenya

To assist in processing of medical claims with a focus on cost control and management of member benefits through linking and coding of inpatient and outpatient bills and capturing in the company medical business operating system(s).

KEY TASKS AND RESPONSIBILITIES

• Reviewing and processing general insurance claims and giving recommendation on settlement or repudiation.
• Capturing of claims as per set rules/guidelines and validate a claim against policy / scheme / guidelines, agreed etc.
• Organizing trainings on document uploads in liaison with key partners and ensuring compliance with the corporate document management policy
• Clean up of the medical claims electronic data management system to ensure an efficient document management system.
• Proactive management of member benefits and reporting of any unusual trends as per the agreed SLA with suppliers and partners.
• Offer Resolution of any missing information required to fully capture a claim by reaching out to the finance payables team.

SKILLS AND COMPETENCIES

• Computer skills
• Good Customer service
• Good Analytical Skills

KNOWLEDGE & EXPERIENCE

Qualifications:

• Qualification- Bachelor’s degree in any medical related fields, Insurance field or Business field.

Experience:

• 1-2 years