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CIC Insurance – Assistant Manager – Claims Vetting.

Get a free C.V. review by sending your C.V. to submitcv@careerassociated.com or click the following link. Submit C.V.! use the subject heading REVIEW.

IMPORTANT: Read the application instructions keenly, Never pay for a job interview or application.

Click the Links Below to Get Job Updates.

https://www.facebook.com/groups/1126060830815705

https://t.me/joinchat/EBWPu0Cfzh880lRySce_AQ


PURPOSE:

Responsible for supervision of claims vetting and audit to ensure all claims paid are according to the company policy and guidelines.

PRIMARY RESPONSIBILITIES:

  • Coordinate and ensure cost containments measures/targets set within the claims vetting section are achieved.
  • Ensure claims vetting and audit daily output targets are achieved and overall levels are maintained within acceptable ranges.
  • Prepare weekly and Monthly reports on claims output, individual and group cost savings, rejections and exclusions.
  • Ensure candidates for wellness and Chronic Disease management are flagged at claims vetting section based on clinical trends for follow-up by the wellness coordinator.
  • Coordinate with claims registration and provider relations department to ensure payments to providers have been settled within the acceptable timelines as per SLAs.
  • Responsible for communication of inadmissible reimbursement claims on clinical matters to the key stakeholders.
  • Coordinate with provider management team and claims registration section to ensure desired provider reconciliations and sign offs are achieved.
  • Provide appropriate recommendations on provider trends to clinical operations team and management for appropriate action.
  • Monitor claims trends to identify high cost providers and together with provider relations team engage providers to ensure desires trends are achieved.;
  • Recommend risk improvement measures for implementation to the underwriting department by monitoring claims experience trends
  • Resolve customer complaints and disputes swiftly, fairly and diplomatically that concerns claims vetting section.

GENERIC DUTIES

  • Carry out performance appraisal, coaching and mentoring staff;
  • Participate in planning and budgeting for the department.

PERSON SPECIFICATIONS

Academic Qualifications

  • Bachelor’s degree in nursing, business or other related fields
  • Registered nurse or clinical Medicine

Professional Qualifications

  • Kenya Registered Nursing (KRN) diploma
  • IIK/CII preferred

Experience

  • Minimum of four (5) years’ relevant experience

Skills and Attributes

  • Excellent communication and presentation skills
  • Problem solving skills
  • Excellent interpersonal skills
  • Good analytical skills
  • Computer literate in MS Office and other office applications
  • Understanding of the working environment /competitors
  • Technical competence in insurance
  • Basic knowledge of regulations by AKI and IRA

If you have the aforementioned professional and academic qualifications and you are ready to execute the above mandate, strictly apply through: https://cic.co.ke/career/

The application should reach us by close of business on 28th April 2022 through. Please note only short listed candidates will be contacted. If you do not hear from us by 26th May 2022 consider your application unsuccessful.

N/B: This job advert is open to both internal and external candidates.

https://cic.co.ke/job/assistant-manager-claims-vetting/

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