Vacancies at Old Mutual Kenya

Job Description

Responsible for ensuring claims processes and services meets the established standards to guarantee efficiency /accuracy by utilizing data analysis and technology to improve claims processing by monitoring and establishing controls for the management of claims costs.

KEY TASKS AND RESPONSIBILITIES

Overseeing Claims Processes:

• Monitor and evaluate the entire claims processing lifecycle to ensure adherence to established standards and procedures.
• Identify areas for improvement in claims processing workflows and implement enhancements.
• Overseeing the claims team addressing the claims backlog, Smart EDI champion and the unregistered claims docket and ensure they deliver set target.

Data Analysis:

• Utilize data analysis tools and techniques to assess claims data, identify trends, anomalies, and opportunities for cost-saving measures.
• Develop reports and dashboards to present data-driven insights to management.

Efficiency Improvement:

• Collaborate with cross-functional teams, including claims processors, IT, and data analysts, to streamline claims processing procedures.
• Implement technology solutions to automate manual tasks and reduce processing times.
• Gather requirements and assist in building and documenting specifications for development (future projects or system upgrade).
• Troubleshoot system issues and follow up to ensure resolved by the specific stakeholders i.e., IT / Smart etc.

Accuracy and Quality Assurance:

• Implement quality control measures to ensure claims are processed accurately and in compliance with industry regulations i.e., Vetter’s Rejection rate / Adherence to the recommendations.
• Conduct audits and quality checks to identify errors and discrepancies in claims processing.

Cost Management:

• Develop and implement cost-containment strategies and controls to reduce claims costs while maintaining quality services.
• Analyze cost-related data to identify areas for cost reduction and optimization.

Standardization and Compliance:

• Ensure that claims processes adhere to established standards, policies, and regulatory requirements.
• Keep abreast of changes in regulations and industry standards and update processes accordingly.

Documentation and Reporting.

• Maintain detailed records of claims processes, controls, and improvements.
• Prepare and present reports outlining process efficiency, cost-saving measures, and compliance.
• Recommend system changes/enhancement upon evaluation of the end-to-end claims processing value chain.

Communication and Training for both Internal and External clients:

• Collaborate with team members to communicate process changes and improvements effectively.
• Provide training and support to claims processing staff to ensure they follow established procedures.
• Ensure timely completion of investigations/resolution arising from claims disputes raised by clients in case management and claims teams.

Computation of discount

• Compute the correct provider discount and advisethe finance team.
• Ensure that discount calculation timelines are met.

Support with data clean up.

• Ensure that client data is accurate in all systems.
• Capture the correct provider details while onboarding them.
• Assist in membership correction to ensure that claims are paid on time and to the correct provider for the correct members.

 SKILLS AND COMPETENCIES

• Decision Making,
• Client Focus,
• Information Monitoring,
• Gaining Commitment
• Team Orientation
• Initiating Action
• Analytical skills
• Problem solving skills

 KNOWLEDGE & EXPERIENCE

• Technical Knowledge
• At least 3 years’ experience
• Proficiency in data analysis tools and software (e.g., Excel, SQL, data visualization tools).
• Knowledge of claims processing procedures and industry standards.
• Proficiency in using computer software and claims processing systems.

 QUALIFICATIONS

• Bachelor's degree in a related field, such as business administration, finance healthcare management, or data analysis, is preferred. Medical background
• Professional license
• Experience in claims processing and vetting
• Quality assurance experience will be an added advantage

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Job Description

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

KEY TASKS AND RESPONSIBILITIES

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

• Verify, audit and Vet medical claims for payment for both outpatient and inpatient claims as per the claim’s manual/Standard operating procedure
• Adhere to customer service charter manual to ensure compliance to agreed turnaround times
• Prompt reporting of any identified risks during claims processing for mitigation.
• Monitor, prevent and control medical claims fraud/wastages during claims processing
• Use of data analytics to review cost and quality of service at medical service providers.
• Hold regular business meetings with service providers to ensure compliance on systems such smart card system and agreed tariffs.
• Evaluate preliminary claim information and revert to broker or insured for more information where necessary to ensure that the correct information is documented for ease in processing of member reimbursement claim
• Respond to client enquiries within 24hrs of enquiry
• Communicate and liaise with medical service providers on resolution of disputed claims
• Any other duties assigned by management.

SKILLS

• Medical Claims Vetting, clinical experience

EDUCATION

• Bachelor of Science in Nursing (BScN) or Diploma in Nursing (KRCHN)

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Job Description

• Enforce underwriting controls including on-barding, certificates, booking of business, documentation.
• Implement underwriting guidelines, process, and procedure to ensure quality underwriting and business.
• Ensure profitability of the branch through quality control and on-boarding.
• Quality documentation timely turn around – TAT.
• Excellent customer service and retention support.
   

go to method of application »

Job Description

• Enforce underwriting controls including on-barding, certificates, booking of business, documentation.
• Implement underwriting guidelines, process, and procedure to ensure quality underwriting and business.
• Ensure profitability of the branch through quality control and on-boarding.
• Quality documentation timely turn around – TAT.
• Excellent customer service and retention support.

KEY RESPONSIBILITIES

• Enforce underwriting controls.
• Ensure clean and accurate data capture.
• Timely preparation of quotations and follow up.
• Debiting of premiums and processing of policy documents within set timelines.
• Processing and checking of underwriting Documents.
• Issuing & signing of Motor Certificates and Yellow cards.
• Ensure that work is done within the set standards of service and TAT.
• Give quality customer service to all clients.
• Safe keeping of security documents.
• Daily scanning and indexing of mails.
• Initiating motor valuation and follow up.
• Adherence to the credit control policy.
• Follow up renewals and ensure maximum retention of profitable accounts.
• Timely processing refunds and follow up.
• 100% Adherence to the authority matrix.
• Ensure registry is fully maintained, orderly and up to date.
• Ensure compliance of AML and PEP guidelines.
• Ensure cross sale and up sale opportunities are maximized.
• Perform any other duties as may be required by the management.

SKILLS AND COMPETENCIES

• Basic Underwriting skills and product knowledge.
• Customer service skills.
• Good Communication Skills.
• Computer Literate.

QUALIFICATIONS (Academic, Professional, Experience)

Qualifications:

• Degree preferably insurance.

Experience:

• 1 year and above.