• Job Type Full Time
• Qualification BA/BSc/HND , Diploma
• Experience 7 years
• Location Nairobi
• Job Field Insurance , Medical / Healthcare
• Review and assess medical claims for accuracy, completeness, and eligibility based on policy terms, medical guidelines, and coding systems
• Attending to providers, specialists and customer queries by determining their requirements, answering to these inquiries, resolving problems, and ensuring good service as a friendly cost.
• Adjudicating inpatient and outpatient medical claims while verifying the accuracy of information provided.
• Oversee quality control processes and claims assessment, adjudication, payment, and communication
• Monitor the quality of services provided by third-party vendors to ensure contractual obligations and service standards are met.
• Bachelor's degree or a Diploma in Nursing, Clinical Medicine, Healthcare Management.
• Strong background in medical claims assessment will be a plus including knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and treatment procedures.
• At least 7 years’ of experience in health insurance claims adjudication, with at least 2 year out of those, in quality assurance.
• Job Type Full Time
• Qualification BA/BSc/HND , Diploma
• Experience 7 years
• Location Nairobi
• Job Field Insurance , Medical / Healthcare
• Review and assess medical claims for accuracy, completeness, and eligibility based on policy terms, medical guidelines, and coding systems
• Attending to providers, specialists and customer queries by determining their requirements, answering to these inquiries, resolving problems, and ensuring good service as a friendly cost.
• Adjudicating inpatient and outpatient medical claims while verifying the accuracy of information provided.
• Oversee quality control processes and claims assessment, adjudication, payment, and communication
• Monitor the quality of services provided by third-party vendors to ensure contractual obligations and service standards are met.
• Bachelor's degree or a Diploma in Nursing, Clinical Medicine, Healthcare Management.
• Strong background in medical claims assessment will be a plus including knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and treatment procedures.
• At least 7 years’ of experience in health insurance claims adjudication, with at least 2 year out of those, in quality assurance.
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