Job Description

Job Title: Claims Analyst

Location: Nairobi

Profile Introduction

Our client, a leading financial and health insurance company seeks to bring on board an Claims Analyst.

The role will be responsible for processing medical claims with a focus on accuracy, cost containment, risk management and customer excellence.

Key Areas of Responsibility

• Review, assess, authenticate and capture outpatient and inpatient claims as per the claims manual and within the set TATs


• Timely scanning, barcoding and batching of received claims


• Processing of reimbursements within the set TATs


• Conduct quality assurance process before batches are authorized for pay run


• Notify brokers and clients of pended and declined claims within set timelines


• Manage pended and declined claims


• Liaise with agents, brokers and service providers on matters arising on claims


• Ensure all claims documents are archived in the relevant systems


• Maintain claims production within set targets


• Generate daily health claims status report


• Storage of all correspondence in Medware system


• Monitoring and processing of NHIF enhanced benefits for cost containment


• Recording and monitoring of roaming and counter-guarantee claims.


• Customer service – address clients’ queries in form of telephone queries, letters, emails and walk –in clients.


• Maintain proper department standards, discipline and confidentiality regarding patients’ illness

Minimum Qualifications:

• Bachelor’s degree/ Diploma in medical, insurance or business-related discipline


• Progress towards Diploma in Insurance will be an added advantage.


• 1 years’ experience in medical claims management in insurance/hospital setting

Core Competencies

• Knowledge of insurance concepts


• Knowledge of medical claims processes and procures


• Knowledge of insurance regulatory requirements


• Stakeholder management


• Customer service


• Good Microsoft Excel skills and math aptitude


• Delivering results and meeting customer expectations


• Interpersonal skills


• Planning and organizing


• Presenting and communicating information


• Persuading and influencing


• Supervisory skills


• Adhering to principles and values

How to Apply

If you are qualified and up to the challenge, please send your CV to vacancies@stratostaff.co.ke by 5 p.m, 27th March 2023.

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