Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange, with operations across Eastern and Southern Africa. The Assistant Health Claims Officer is responsible for the effective processing of medical claims. This involves verifying and updating information for submitted claims and reviewing work processes to determine accurate reimbursement. The role includes assessing reimbursement policies, performing reconciliations with claims estimates, conducting payment negotiations, and providing essential support throughout the medical claims process.
Key Responsibilities
Claim Parameters: Set appropriate parameters for each admission, including claim reserves, initial authorized costs, and duration.
Client & Provider Interaction: Communicate with clients and service providers to ensure care is delivered within policy guidelines.
Compliance: Review medical reports and claims for compliance with set guidelines and liaise with underwriters on the scope of cover for various schemes.
Pharmacy Management: Discourage polypharmacy by challenging prescriptions and suggesting alternatives; encourage the use of generics to reduce pharmaceutical expenditure.
Authority: Act within the approved Delegated Authority Matrix.
Reporting: Prepare periodic management reports on medical claims and ensure processing within stipulated timelines.
Additional Duties: Perform any other assigned duties as required.
Qualifications and Experience
Education: Diploma or Degree in Nursing, or a Diploma in Clinical Medicine, or a Diploma in Pharmacy.
Experience: 2-4 years of experience in a claims management position within a busy insurance environment or insurance company.
Knowledge: Moderate understanding of insurance concepts.
Interested and qualified candidates should apply through the Britam career portal via the Taleo system. Use the following link to begin your application: https://www.myjobmag.co.ke/apply-now/1172315
