Jobs at Jacaranda Maternity

We have big ambitions and require a Insurance Claims & Reconciliation Officer at our hospital. Reporting to our Finance Manager, you will take on responsibility of delivering quality customer service and maintaining superior patient satisfaction. 
Will you join us and help transform maternal and new-born health care in East Africa?
Key Duties & Responsibilities:
Claims Management

• Collect, verify, and prepare insurance claims with supporting documents (invoices, pre-authorizations, medical reports);
• Submit claims to insurers within stipulated timelines and monitor acknowledgment of receipt;
• Track claims at every stage to ensure timely settlement;
• Maintain an updated claims register with details of claims submitted, amounts, dates, and statuses;

Reconciliation & Payment Processing

• Reconcile insurer remittances against submitted claims, ensuring accuracy and completeness;
• Investigate and resolve variances, rejections, partial payments, or delays in settlement;
• Prepare reconciliation statements and submit to the Finance Manager;
• Work with Accounts Receivable to ensure insurance payments are correctly posted;

Follow-Up & Dispute Resolution

• Liaise with insurance companies and third-party administrators to resolve disputed or pending claims;
• Escalate unresolved claim issues to management for intervention;
• Maintain strong working relationships with insurer contacts to facilitate quick resolution;

Compliance & Risk Management

• Ensure all claims adhere to hospital policies, insurer requirements, and regulatory standards;
• Monitor and report on trends in claim rejections or denials, recommending preventive measures;
• Safeguard confidentiality of patient and insurer information in line with data protection regulations;

Reporting & Analysis

• Prepare periodic reports on claims submitted, amounts recovered, outstanding balances, and rejection trends;
• Provide management with insights on performance of different insurers and highlight areas of concern;
• Support preparation of monthly, quarterly, and annual financial reports related to insurance recoveries;

Stakeholder Coordination & Process Improvement

• Collaborate with clinical, billing, and administrative teams to ensure accurate patient data and claim documentation;
• Train or sensitize staff on proper documentation practices to reduce claim rejections;
• Recommend process improvements to reduce turnaround times and increase claim recovery efficiency;
• Keep updated with changes in insurance policies, tariffs, and regulations, and advise management accordingly;
• Any other duties as may be assigned.

Qualifications:

• Bachelor’s degree in Accounting, Finance, Business Administration, or related field;
• Professional qualification such as CPA, ACCA, or equivalent is an added advantage;
• A nurse or clinical officer with experience in medical insurance claims management in a reputable insurance company will also be considered;
• At least 3–5 years’ experience in insurance claims processing, healthcare finance, or medical billing;
• Strong understanding of insurance claim cycles, healthcare schemes, and billing processes;
• Proficiency in MS Excel, accounting systems, and ERP platforms;
• Previous experience in a hospital or insurance company environment preferred;

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We place great value in candidates who are fantastic communicators in verbal and written forms, and for this role, being able to translate and clearly explain technical concepts in “plain English” while also transforming non-technical concepts into actual technical specifications that can be executed. 

Technical Skills

• 4+ years experience with PHP: Given the reliance on PHP 5.6, in-depth knowledge of PHP, including experience with upgrading and securing PHP applications, is crucial.
• 3+ years experience with Database Management and Optimization: Proficiency in MySQL, including the ability to design, optimize, and secure databases. Experience with MySQL user account management and log analysis tools is essential. Comfortable writing application logic for data retrieval and storage; able to craft intermediate to advanced queries for data analysis.
• 2+ years experience with Python: Demonstrated experience designing, developing, and maintaining applications in Python applications.
• 3+ years experience with Infrastructure Management: Strong experience with server and network infrastructure management, including virtualization technologies, server hardware.
• 3+ years experience with Cloud Services: Strong experience developing and maintaining applications on AWS, Azure, or GCP.
• 2+ years experience with Security and Compliance: A strong understanding of IT security best practices, data protection laws and compliance requirements, particularly in managing and securing sensitive medical data.
• Software Development Practices: Familiarity with modern software development practices, including version control, continuous integration/continuous deployment (CI/CD), and agile methodologies.

Strategic and Managerial Skills

• Project Management: Ability to oversee complex projects, from planning and execution to monitoring and closing, ensuring they are delivered on time, within scope, and budget. As an organization we place a large emphasis on being able to articulate and track progress using formal project management software, which we will provide.  
• Change Management: Experience in managing technology change, including system upgrades and migrations, with minimal disruption to business operations.
• Team Leadership and Development: Skills in leading, mentoring, and developing IT teams, fostering a culture of innovation, accountability, and continuous improvement.
• Vendor and Stakeholder Management: Proficiency in negotiating with and managing vendors, as well as engaging with stakeholders across the organization to gather requirements, report progress, and align IT initiatives with business objectives.

Communication and Analytical Skills

• Effective Communication: Strong verbal and written communication skills, with the ability to explain complex technical issues to non-technical stakeholders and facilitate productive discussions.
• Problem-Solving and Analytical Abilities: Exceptional problem-solving skills, with a knack for analytical thinking and the ability to use data to inform decisions, optimize operations, and resolve issues.

Adaptability and Continuous Learning

• Adaptability: The IT landscape is continuously evolving, so the IT manager must be adaptable, staying abreast of new technologies and best practices that could benefit the company.
• Learning and Development: A commitment to personal and professional development, encouraging a learning culture within the IT team to ensure skills remain up-to-date and relevant.