Medical Administrators Kenya Limited (MAKL) – Clinical Officer – Claim Analysts (Mombasa, Busia and Nairobi Branch)

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Reports to Team Leader – Medical Operations
Level Executive Level – 2 years’ experience in a busy hospital

Principle Role

A clinical officer who will be able to apply their medical expertise in Medical insurance claims processing

KEY RESPONSIBILITIES AND DELIVERABLES:
  • Responding to pending issues from service providers.
  • Ensuring set targets are met and TAT observed and achieved.
  • Vetting and processing of reimbursements.
  • Process Company’s response to claims/Preauth
  • Monitoring inventory records.
  • Coordination of claims/Preauth processing.
  • Follow up with providers for bills, discrepancies in bills and other information that is holding up processing.
  • Respond to client enquiries on claims through e-mail, phone or directly.
  • Resolve problems related to claims/preauth by liaising with Medical service Providers panel.
  • Clinical officer has to be well equipped with the latest trends and technologies used.
  • Expert in drafting the process in and out.
  • Smart in tackling various types of clients.
  • Supervising the educational material provided to patients by clinical officer.
  • Evaluating the Preparation and delivery of claims presentations by clinical officer.
  • Provide cover for colleagues in their absence, ensuring that the handling of their Preauth/claims is kept up to date.
  • Liaising with other healthcare personnel for efficient delivery of patient care.
  • Responding to mails, calls, and medical related queries on social media platform.
  • Any other duties as may be assigned.

QUALIFICATION AND EXPERIENCE

Minimum Qualifications and Experience Requirements
  • Diploma clinical medicine and surgery.
  • Registered and licensed by the relevant medical body.
  • Minimum of 3 years of experience in relevant medical field
  • Experience in the Health Insurance industry will provide an added advantage
  • Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
  • Knowledge and experience in reading, analyzing, and interpreting reports and support procedures.
  • Proficiency in MS Office – specifically Excel, Access, Word, PowerPoint.
  • Ability to effectively present information and respond to questions from management, peers and customers.
  • Self-driven, customer centric , team player and good communication Skills
  • Willingness to go the extra mile.

How to Apply

Please submit your updated CV with a cover letter via email to recruitment@makl.co.ke for review on future positions.

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MAKL

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