Latest Recruitment at Old Mutual Kenya

Job Description

The Health Insurance QA Officer is responsible for ensuring the accuracy and compliance of health insurance claims processing within the organization. This role involves reviewing claims, identifying errors or issues, and implementing corrective actions to improve quality assurance processes.

KEY TASKS AND RESPONSIBILITIES

Quality Audits Of Claims.

• Identify Providers with significant billing irregularities or suspected of fraud and have regular provider engagement issues on billing.
• Review claims that relate to benefit excesses, assign liability, and recover while ensuring the root cause is addressed.
• Admissions tracking; checking on exaggerated bills, unnecessary admissions or overstay admissions, and doctors’ charges.
• Review system rejections of claims for root causing and resolution.
• Quality audits on the vetters and ML module to identify quality gaps and remediate them.
• Identify and investigate any errors, discrepancies, or quality issues in the claims processing procedure
• Collaborate with various departments (e.g. underwriting, provider relations, IT) to resolve complex claims issues

Reporting and Trend Analysis.

• Prepare objective reports on processes that lead to leakages and proposed mitigative measures.

• Review claims, and provide recommendations to claims, retention, case, and provider relations teams on trends noted: both from users and providers.
• Make recommendations to management regarding developing policies, processes, and procedures; identify and implement processing efficiencies; identify trends and continuing education opportunities.
• Manage reserve philosophy for admission/approved and or enhanced amounts through weekly audits to ensure the acceptable threshold is being met.
• Review reimbursement reports to pick exceptions and cold calling/impromptu visits to validate.
• Conduct regular process audits to enforce adherence to laid out SOPs across the health business
• Maintain proper documentation of call performance and associated corrective measures as applicable

Training and Feedback

• Designing effective training programs and collaborating with trainers to ensure the feedback loop from the QA audits is complete.
• Identify knowledge gaps and training needs of the relevant teams and hold calibration sessions and breakout training sessions as needed.
• Develop and implement quality control measures to prevent future errors and improve efficiency
• Stay up-to-date with changes in healthcare laws, regulations, and best practices related to claims management.
• Prepare regular claims reports to management and advise on relevant claims findings for medical risk review.
• Ensure all audit items are closed in your respective area.

Systems Enhancement

• Continuously review the effectiveness of workflow systems and recommend enhancements.
• Provide input on ML and core system enhancements to improve quality and output.

Any other tasks/duty as may be assigned by the Line manager.

SKILLS AND COMPETENCIES

• Aligns Execution - Planning and prioritizing work to meet commitments aligned with organizational goals.
• Proficiency with claims management software and data analysis tools
• Motivated team player who is detail-oriented.
• Excellent communication skills, both written and verbal
• Strong working knowledge of the Microsoft suite of products
• Strong analytical, problem-solving and decision-making abilities.

KNOWLEDGE & EXPERIENCE

• 3+ years experience in Quality Assurance/Medical claims/Case management In-depth knowledge of healthcare operations, claims processing, and regulatory requirements.
• Experience working in the Insurance industry preferred.
• Knowledge in data analysis and statistics are desirable.

QUALIFICATIONS

• Bachelor's degree in Healthcare Administration, Nursing, Statistics Clinical Medicine or a related field

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Job Description

The telesales officer is responsible for driving digital sales by engaging with customers via phone and other digital communication channels. This role focuses on promoting company products and services, closing sales, and nurturing customer relationships. The ideal candidate will excel at meeting sales targets and delivering outstanding customer experiences while leveraging digital tools and platforms.

KEY TASKS AND RESPONSIBILITIES

• Communicate with customers following established guidelines to address inquiries and resolve issues.
• Develop a deep understanding of the company’s products and services to make personalized recommendations.
• Actively generate, qualify, and pursue leads to achieve individual sales targets.
• Initiate and manage customer interactions through phone calls and digital platforms.
• Maintain and manage a sales pipeline, providing regular updates to team leaders.
• Effectively handle customer objections to close sales and ensure satisfaction.
• Build and sustain positive relationships with customers to drive repeat business.
• Utilize CRM and other digital tools to record interactions and manage customer data efficiently.
• Promote and upsell additional products and services during customer engagements.
• Prepare and submit sales performance and activity reports to management. Meet or exceed defined KPIs, including call volume and conversion rates

SKILLS AND COMPETENCIES

• Proficiency in Windows-based applications (e.g., MS Office) and CRM systems.
• Excellent verbal and written communication skills with a customer-first attitude.
• Strong analytical skills to assess customer needs and provide tailored solutions.
• Proven ability to handle objections and negotiate effectively.
• Goal-oriented with a track record of consistently meeting or exceeding sales targets.

KNOWLEDGE & EXPERIENCE

• Success in meeting or exceeding sales targets in telesales or digital sales roles.
• Experience in the insurance, financial services, or digital sales sector is highly preferred
• Proficiency with CRM systems, digital tools, and MS Office applications.
• Strong ability to build relationships and deliver tailored solutions to customer needs.
• Excellent verbal and written communication skills with strong negotiation abilities.
• At least one year of insurance experience and progress toward certifications (e.g., ACII, COP) is preferred.

QUALIFICATIONS

• Diploma or degree in a business-related field (e.g., Marketing, Sales, Business Administration).
• Progress toward insurance certifications such as ACII (Associate of the Chartered Insurance Institute) or COP (Certificate of Proficiency in Insurance) is preferred.
• A minimum of one year of experience in sales, preferably in insurance or digital sales environments

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Job Description

Reporting to the Business Processing corporate Supervisor, the incumbent will optimally carry out corporate business processing in the department and ensure that customer standards are met.

KEY TASKS AND RESPONSIBILITIES

• Ensure completeness of insurance documentations – KYC. These will include accurate details in the proposal forms, fully filled Group application form, COI, CR12, PIN Certificates and checklists
• Premiums Processing for schemes in the system as per the provided quote ensuring it is tallying with the manual invoice shared with the client
• Process underwriting documentation. Ensuring that all introduced schemes have been reviewed and approved by the underwriter
• Respond to inter departmental queries and complaints in a timely manner
• Support the credit control team in adhering to their policies and procedures
• Membership Management- Deletions, additions, member lists, deactivation letters etc. Always ensuring that you have instructions from the scheme contact person
• Preparation of Virtual Medical cards, activation, deactivation.
• New medical scheme set ups- Ensuring you have received the member list, underwriting summary, and instructions to proceed with onboarding of the scheme.
• Resolve any customer complaints/issues/concerns in a prompt and professional manner, where necessary escalate to the various departments/authorities for closure.
• Maintaining and updating the renewal tracker, card tracker and uploading of documents in share point.
• Provide excellent and prompt customer service for maintenance of a positive reputation for the business.

SKILLS AND COMPETENCIES

• Sound Technical Underwriting skills.
• Intensive and extensive product knowledge
• People Management and Overall Managerial Skills
• Good analytical skills
• Customer service skills
• Good Communication Skills
• Computer Literate with good knowledge of Excel

KNOWLEDGE & EXPERIENCE

• Minimum 2 years’ experience.

QUALIFICATIONS

• Degree in insurance or business related.
• Professional qualifications (CII or IIK) or good progress

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Job Description

• Follows standardized processes and provides administrative support in line with normal business functioning. Delivers on daily production standards and adheres to service and quality standards. Provides an indirect service to customers and intermediaries. Responds to immediate requirements within procedure. Uses standard administrative techniques to co ordinate own work. Product and process knowledge in different areas may differ but basic skills remain the same. Technical knowledge is limited to some products and or processes.

KEY TASKS AND RESPONSIBILITIES

• Ensure completeness of insurance documentations - KYC
• Prepare Renewal lists and process renewal notices
• Premiums Processing
• Process underwriting documentations
• Prepare policy documents/ contracts
• Respond to inter departmental queries and complaints in a timely manner
• Assist in credit control by ensuring no unpaid business is not booked
• Membership Management- Deletions, additions, member lists and deactivation letters.
• Preparation of Medical cards, activation, deactivation and issuance

SKILLS AND COMPETENCIES

• Attention to detail and accuracy
• Good communication skills
• Ownership & Commitment
• Customer Focus
• Honesty and integrity
• Good assessment and analytical skills
• Ability to work with cross functional teams.
• Ability to meet strict deadlines.
• Proficient with Microsoft Office Suite or related software
• Strong analytical, data and reporting skills.

KNOWLEDGE & EXPERIENCE

• A degree in Actuarial Science or Business-related field
• Entry level
• Confidential

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Job Description

To control and manage medical benefit utilization through preauthorization and case management activities and ensure quality, appropriate cost-effective care and good customer service

KEY TASKS AND RESPONSIBILITIES

• Pre-authorize scheduled and non-scheduled admissions within the set guidelines.
• Negotiate/discuss professional fees as appropriate for each admission.
• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
• Visit all admitted clients within Nairobi region and its environs
• Liaise with Doctors on the day-to-day management of patients and obtain medical reports/ expected length of stay where indicated.
• Ensure smooth discharge process and co-ordinate any necessary post-hospitalization/ step down facility care.
• Revise reserves after discharge of member.
• Collect feedback from admitted clients on quality and scope of service by the service provider.
• Assist in carrying out verification and medical audit of claims/invoices before settlement.
• Develop and maintain monthly database on admissions, large claims and extended length of stay. 
• Respond to queries from clients, intermediaries and service providers.
• Liaise with other medical underwriter for purposes of market surveys and development of new controls, standards and products.
• Any other duty assigned by management.

SKILLS AND COMPETENCIES

• Excellent communication and negotiation skills.
• Excellent public relations and interpersonal relationship skills.
• Extensive networking with SP and other medical insurers.
• Excellent analytical and monitoring skills
• Good IT skills in database management and office systems.
• Good decision making in benefit utilization management.
•  High levels of integrity and honesty

QUALIFICATIONS, KNOWLEDGE & EXPERIENCE

• Diploma or Degree in Nursing                     
• Diploma in Insurance/ COP
• Degree in Health systems Management/ Business management 
• 3 years’ experience in clinical setting +2 years in insurance set up