Deputy Medical Claims Manager Job in Kenya - Insurance & Financial Services Company
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:
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 manuals
- Verification 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.
Qualifications:
- Diploma or Degree in Nursing
- Diploma in Insurance and or a degree in Health systems Management/ Business management will be an added advantage
Key Competencies:
- 2 years experience in clinical setting
- At least 3 years of experience working as a claims team leader in a busy insurance environment
- Excellent communication and negotiation skills.
- Excellent public relations and interpersonal relationship skills.
- Extensive networking with SP and other medical insurers
- Excellent analytical and monitoring skills
- User IT skills in database management and office systems.
- Ability to evaluate decisions made in benefit utilization management.
- Integrity and honesty
f you are qualified and up to the challenge, please apply via our Careers page on www.altimaafrica.com.
Deadline for application is Friday 27th April, 2012.
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