Summary
Date Posted: Wednesday, August 04, 2021 , Base Salary: Not Disclosed

JOB DETAILS:
Job title: Claims Manager- Healthcare
Purpose of the Job
Develop and oversee the claims management strategy for healthcare business that ensures medical claims management is in line with the business strategic plan.

Duties and Responsibilities
• Develop policies and procedures that guide the management of medical claims to ensure compliance with the specific client’s service level agreements as well as insurance regulations.
• Develop processes for claims management to support efficiency and effectiveness - Processing and Payment of claims to all providers in line with the standard service agreement as well as the contractual agreement therein.
• Claims Review and Approval - Review claims processed to ensure that all claims fall within scope of respective medical insurance policy and comply with claims management policies and procedures.
• Attend to escalated and complex medical claims to ensure these are attended to in a timely manner, and that they do not expose the business to any risk.
• Risk Supervision - Overall process management to shield the company from any potential liability emanating from claims processing.
• Business Advisory – Monitor and review claims trends and provide necessary advisory to the business for decision-making, innovation, and strategy review.
• Claims Records management & Reporting.
• Continuous process Audit and Fraud management
• People Management - Develop staff by sharing knowledge, mentoring, coaching, and training and to ensure full range of performance management processes and procedures.

Qualification
• Degree in Nursing, Clinical Medicine or Pharmacy
• Professional qualification in Insurance (AIIK or ACII) will be an added advantage.
• 7 years in health insurance operations 3 of which must be in a managerial role.

Competencies
• Knowledge of insurance industry and concepts
• Knowledge of insurance regulatory requirements
• Formulation of strategies and concepts
• Business management skills
• Strong personality with interpersonal sensitivity
• Leadership skills
• Quality decision making skills.
• Listening skills
• Conflict handling skills
• Presentation skills
• Good written and verbal communication skills
• Proactive
• Team player
• Strong negotiation skills
• Creative & open-minded
• High level of numeracy and strong analytical skill

Work Hours: 8

Experience in Months: 84

Level of Education: Bachelor Degree

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Job application procedure
Interested candidates who meet the above qualifications to send their applications to recruitmentkenya@minet.co.ke
Please indicate the job title as the subject. Only shortlisted candidates will be contacted.

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