Healthcare and MedicalFull-TimeJunior-level(1-2 yrs)
Job Description
About the Role
The Optometrist will support the insurance healthcare function by evaluating optical approval requests and claims, ensuring clinical accuracy, managing provider relationships, driving cost-efficiency, and upholding service delivery standards. The role ensures timely approval of optical requests, reduction of fraud, and compliance with regulatory and internal audit requirements, while safeguarding client satisfaction and protecting the company’s brand values.
Duties and Responsibilities
Client Service & Communication
Maintain high-quality communication with clients.
Provide accurate and timely responses to clients and service provider queries, ensuring alignment with service-level expectations.
Optical Claims & Approvals Management
Achieve and maintain an agreed optical approval Turnaround Times (TATs).
Conduct clinical validation of optical prescriptions, lens choices, and diagnoses to prevent fraud, inappropriate costing, or incongruent prescriptions.
Monitor and retain Optical TAT reports; share summaries and insights with management through the supervisor regularly.
Cost Management & Provider Negotiations
Drive annual cost savings through discount negotiations, detection of fraudulent plans or costing, and optimization of claim approvals.
Negotiate reduced optical costs.
Conduct service provider quality assurance audits annually, assessing clinical and commercial standards; prepare detailed post-audit recommendation reports.
Perform any other duties as may be assigned by the supervisor.
Key Result Areas
Call Centre support - Customer service
Cost Management / Cost containment
Customer satisfaction
Team Cohesion
Key Competencies
Strong analytical and clinical assessment skills
Excellent negotiation and provider relationship skills
High attention to detail and accuracy
Strong communication and client management capability
Ability to work under pressure while maintaining service-level standards
Ethical judgment and commitment to continuous improvement
Knowledge and Skills Required
Optical background & knowledge
Data Analytics & Computer Literacy
Flexibility
Teamwork
Time Management
Excellent verbal and written communication skills; solution-oriented
Valid professional practicing license
Minimum 2 years’ experience in optical practice or claims assessment (insurance experience is an added advantage)
Strong knowledge of optical products, clinical diagnostics, claims processes, and fraud detection
Proficiency in healthcare management systems and MS Office Suite
Professional and Academic Qualifications
Bachelor’s degree or Diploma in Optometry or Ophthalmic Clinical Sciences
How to Apply
Interested and qualified candidates are invited to apply online by visiting the Minet Kenya application portal here.
