Claims Analyst at Stratostaff
Stratostaff
- Kenya
- Permanent
- Full-time
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- Company:
- Location: Kenya
- State:
- Job type: Full-Time
- Job category:
- Review, assess, authenticate and capture outpatient and inpatient claims as per the claims manual and within the set TATs
- Timely scanning, barcoding and batching of received claims
- Processing of reimbursements within the set TATs
- Conduct quality assurance process before batches are authorized for pay run
- Notify brokers and clients of pended and declined claims within set timelines
- Manage pended and declined claims
- Liaise with agents, brokers and service providers on matters arising on claims
- Ensure all claims documents are archived in the relevant systems
- Maintain claims production within set targets
- Generate daily health claims status report
- Storage of all correspondence in Medware system
- Monitoring and processing of NHIF enhanced benefits for cost containment
- Recording and monitoring of roaming and counter-guarantee claims.
- Customer service - address clients' queries in form of telephone queries, letters, emails and walk -in clients.
- Maintain proper department standards, discipline and confidentiality regarding patients' illness
- Bachelor's degree/ Diploma in medical, insurance or business-related discipline
- Progress towards Diploma in Insurance will be an added advantage.
- 1 years' experience in medical claims management in insurance/hospital setting
- Knowledge of insurance concepts
- Knowledge of medical claims processes and procures
- Knowledge of insurance regulatory requirements
- Stakeholder management
- Customer service
- Good Microsoft Excel skills and math aptitude
- Delivering results and meeting customer expectations
- Interpersonal skills
- Planning and organizing
- Presenting and communicating information
- Persuading and influencing
- Supervisory skills.
- Adhering to principles and values.
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