Clinical Officer – Claim analysts (Mombasa Branch , Busia Branch and Nairobi Branch) at Medical Administrators (K) Limited (MAKL)

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.