Claims Analyst Job at Old Mutual Kenya… See details on how to apply for the opportunities available at Old Mutual Kenya.
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Descriptions;
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Old Mutual Kenya is based in Nairobi and is part of a larger group that offers solutions in long-term savings, asset management and investment. We offer solutions to individuals and corporates underpinned by our core values which are: Respect, Integrity, Accountability and Pushing beyond boundaries.
RESPONSIBILITIES:
- 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.
Requirements
Skills: Medical Claims Vetting, clinical experience
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Education: Bachelor of Science in Nursing (BScN) or Diploma in Nursing (KRCHN)
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