Vacancies at CIC Insurance

PURPOSE:

To provide general customer service in respect to medical business customers.

PRIMARY RESPONSIBILITIES:

• Receive and respond to Medical emergency lines and ensure 24 hour coverage.
• Resolve customers’ communication through electronic and physical channels (Emails and walk in clients).
• Issuance of both in and outpatient approvals for admissible requests for insured members.
• Communication to stakeholders on management of cases and financial liability through reports.
• Provide input for the customer service reports.
• Handle customer service issues and queries.
• Escalate Customer queries to the relevant job role if necessary.
• Promote the organization’s customer service charter.

 Academic and Professional Requirements

Education  

• Minimum of a Diploma in Nursing (KRCHN) 
• Computer literate in MS Office and other office applications 
• Customer Experience training will be an added advantage

Experience Required:

• Relevant experience in busy health environment    3   
• Experience in a medical call centre management unit    1

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PURPOSE:

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

PRIMARY RESPONSIBILITIES:

• Vet and audit inpatient and outpatient medical bills/invoices in order to pay service providers promptly.
• Process reimbursement claims within the stipulated TAT.
• 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 stakeholder queries and complaints promptly and professionally
• Recommend risk improvement measures to the underwriter to take appropriate action.
• Fraud detention within claims function and escalation of any suspicious claims to the supervisor

Academic and Professional Requirements

Education 

• Minimum of a Diploma in Nursing (KRCHN)  
• Computer literate in MS Office and other office applications  

Experience Required:

• Relevant experience    3

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PURPOSE:

Responsible for receiving and processing claims for provider payment.

PRIMARY RESPONSIBILITIES:

• Ensure that all claims received are well stamped and keyed in for future reference.
• Dispatch received invoices, mails and claim books to respective sections
• Dispatch claim forms and other relevant documents to providers
• Confirm that smart claims have been billed correctly
• Prepare valid claims for scanning.
• Upload, attach and index relevant documents to Document Management System
• Facilitate discarding of scanned claim documents as per the approved disposal procedure.
• Registration of medical claims in the system
• Follow up on registration and reconciliation of provider statements to ensure closure.
• Follow through to ensure all claims with issues at registration level have been addressed or escalated to the supervisor for action
• Respond to walk in customer enquiries
• Attend to customer and service providers’ queries and complaints promptly and professionally

Academic and Professional Requirements

Education    

• Bachelor’s Degree/Diploma    
• Bachelor’s degree in a business related field or a Diploma in Health Records 
• Computer literate in MS Office and other office applications 

Experience Required:

• Relevant experience    1