• Medical Claims Anayst Job at Britam

  • Posted on: 5 December, 2016 Deadline: 9 December, 2016
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    Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique and Malawi. The group offers a wide range of financial products and services in Insurance, Asset management, Banking and Property. Our Mission is to provide outstanding financial services to our customers. Our Vision is to be the most trusted financial service partner. We aim to provide our clients, with an unmatched offering, ensuring first class solutions that help secure the future.

    Medical Claims Anayst (Pharmacist)


    Key responsibilities

    • Audit and Verify outpatient, inpatient and reimbursement claims as per clinical guidelines and within the recommended guided tariffs.
    • Ensure regulatory control and drug management on all prescriptions ensuring advice on adverse drug reactions are suspected, or where potential on drug interactions existing and ensuring dosage and medicines are accurately prescribed.
    • Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
    • Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
    • Price guided tariffs- building of provider pricelists especially for bigger providers on average pharmaceutical expenditure.
    • Trend Analytics – Analysis of prescription patterns for providers and prescription drug use by members based on system-generated reports.
    • Involvement and participation in formulation of the CPT codes for medicines to track expenditure and provide trend analysis.
    • Training of medical claims team on current treatment protocols on need basis and best practise.
    • Audit independent pharmacies and pharmacies within the various hospitals.
    • Providing of novel strategies on reduction of the company’s pharmaceutical expenditure.
    • Develops and maintains networks within pharmaceutical sector, keeps updates on current practices, participates in professional societies
    • Outsourcing of non-pharmaceutical equipment with an aim to reduce costs on hospital mark ups.
    • Good clinical acumen and keeps up to date with latest trends as provided by ministry of health and any other global bodies
    • Provide technical support to the claims team on queries revolving around prescription of drugs.
    • Promptly and efficiently attend to customer queries, and complaints perform any other duties as may be assigned from time to time.

    Key Performance Measures

    • Saving the Company money from wastage and exorbitant fees by providers.
    • Medical fraud mitigation
    • System support and integration on CPT coding 
    • Knowledge, experience and qualifications required
    • Diploma in Pharmacy
    • At least two years of practise in a busy hospital set up or
    • At least two years’ experience in medical claims processing in insurance set up
    • Registered with the Pharmacy and Poison board.
    • Basic knowledge of insurance concepts
    • Knowledge of claims processes and procedures
    • Proficient in use of Microsoft office suites and packages

    Core competencies

    • Good Communication skills
    • Building Relationships
    • Focuses on the Customers
    • Develops Self

    Closing Date: Friday, December 9, 2016

    Key Skills/Specialization:

    • Diploma in Pharmacy
    • At least two years of practise in a busy hospital set up or At least two years’ experience in medical claims processing in insurance set up
    • Registered with the Pharmacy and Poison board.

    Method of Application

    Interested and qualified? Go to Britam career website on careers.britam.com to apply

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