Latest Recruitment at Stratostaff

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

Requirements

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

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Key Areas of Responsibility

• Keep detailed and accurate records of health business policies underwritten and decisions made (both in medcare and in physical files).
• Assist in underwriting health insurance risks
• Carry out scheme performance analysist and propose appropriate renewal terms
• Participate in the preparation of quotations within set standards
• Prepare policy documents, endorsements debits and credit notes
• Dispatch policy documents, new business and renewal debits and endorsements within the set time frames.
• Assist in the renewal of policies in the system within the set time frame.
• Attend to correspondence and client queries (both written and by phne) within the set time frames.
• Attend to correspondence and client queries within set timelines
• Prepare reports as may be required from time to time.
• Debt management at business entry point and renewal in line with the credit policy.
• Implementation of policy suspension and policy cancellations
• Liaison with the other departmental and company functions to ensure smooth delivery of services to insured clients
• Implementation of TCF
• Provider liaison to ensure that all providers have updated scheme and membership records
• Reconciliation of smart applications and medware records to ensure data consistency.

Requirements

Minimum Qualifications:

• Bachelor’s degree in insurance or business related discipline.
• Progress towards Diploma in Insurance (ACII, or AIIK), (at least three papers or equivalent).
• 2 years’ experience in insurance industry

 Core Competencies

• Customer, market an competitor understanding
• Knowledge of insurance industry and concepts
• Knowledge of insurance regulatory requirements
• Knowledge of medical underwriting processes, procedures and concepts
• Negotiation skills
• Business management skills
• Excellent analytical skiils
• Excellent organizational and stakeholders management skills
• Result driven
• Adapting and responding to change
• Planning and organization
• Presenting and communicating information
• Persuading  and influencing
• Interpersonal skills
• Adherence to principles and values