Our Client, a leading insurance and financial services company in East Africa seeks to recruit a Deputy Medical Claims Manager. (S)He will be reporting to the Medical Claims Manager.
Main Purpose
To control and manage medical claims processes & procedures through the use of effective techniques to achieve the objectives of claims cost control, operational efficiency and meeting of the customer service charter in claims payment.
Responsibilities:
Oversight of the claims process flows to ensure efficiency in processing of claims as per the company medical claims procedure manualsVerification and audit of outpatient and inpatient claims as per the claims manual and customer service charter manual to ensure compliance and mitigate risk.Negotiate professional fees and hospital charges including discounts to control expenditure.Oversee processing, settlement of all claims and authorize requisitions.Holding regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs.Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers.Supervise, train and mentor medical claims staff to achieve a high level of motivation and productivity by the team.Prepare regular claims reports to clients, management and advice underwriter health on relevant claims findings for medical risk review.Diploma or Degree in Nursing Diploma in Insurance and or a degree in Health systems Management/ Business management will be an added advantage2 years experience in clinical settingAt least 3 years of experience working as a claims team leader in a busy insurance environmentExcellent communication and negotiation skills.Excellent public relations and interpersonal relationship skills. Extensive networking with SP and other medical insurersExcellent analytical and monitoring skillsUser IT skills in database management and office systems.Ability to evaluate decisions made in benefit utilization management.Integrity and honesty How to Apply:
If you are qualified and up to the challenge, please send applications to kenyanrecruiter@gmail.com, indicating on the subject line the role title.
Please note that only qualified candidates will be contacted.
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