Overview

Clinical Officer – Claim analysts (Mombasa Branch , Busia Branch and Nairobi Branch)
Job TypeFull Time
QualificationBA/BSc/HND
Experience3 years
LocationNairobi
Job FieldMedical / Healthcare
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.

MODE OF APPLICATION

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About Medical Administrators (K) Limited (MAKL)

Medical Administrators (K) Limited (MAKL) was founded in 2018 to fill the gap in Health Insurance Administration in Kenya, with a client-focused approach. Our objective is to enhance customer experience, bring in greater efficiency in health insurance administration and claim processing. We believe this will help curb or reduce medical billing related fraud even as we bridge direct relationships amongst insurance providers, healthcare providers and scheme members.