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Job Ref. No. HRJIC626
Position: Claims Approver
We currently have an exciting career opportunity for Claims Approver, Jubilee Health Insurance Limited. The position holder will report to the Claims Team Leader and will be based at Head Office in Nairobi.
Under general supervision, the role holder is responsible for Claims assessment and approval in line with standards, policies and procedures while consistency meeting daily targets.
1. Assess claims to ensure details are captured correctly. Member name, diagnosis, provider and invoiced amounts tally on the claim form, letter of undertaking and the system
2. Confirm membership validity and benefits before processing claims
3. Review patients’ history and records to determine cause of disease or disorder and assess if treatment and prescription recommended correlates with the diagnosis
4. Identify candidates for referral for specialist care and communicate the same to care managers
5. Confirm that treatment given is in adherence to provider panel rules of eligibility as well as customary and reasonable pricing
6. Provide training and guidance to team members on emerging issues around claims assessment
7. Identify fraudulent claims with an aim to reduce claims costs and enable prudent benefit management for members
8. Contributing to reports on utilization, average costs of treatment and others as required.
1. Proficient in Actisure
2. Performance reporting and management
3. Health Benefits Plan Management
4. Intelligence and Business Development skills
5. Policy Interpretation
6. Customer Service
1. Diploma or a Bachelor’s degree in any Health care related field
2. Registration by regulatory body
3. Insurance Professional qualification (AIIK/CII)
1. Knowledge of medical insurance claims processes and procedures
2. Knowledge and experience in the insurance concepts & regulatory requirements
3. Basic understanding of the concepts of insurance
4. Proficient in the use of Microsoft office suite and packages
If you are qualified and seeking an exciting new challenge, please apply via Recruitment@jubileekenya.com quoting the Job Reference Number and Position by 18th June 2021.
Only shortlisted candidates will be contacted.