Medical Claims Assessor at Jubilee Insurance

About the Role

A dynamic team is expanding and looking for the right talent to join as a Medical Claims Assessor. In this role, you will be responsible for reviewing, assessing, and processing medical claims while ensuring compliance with all regulatory requirements and company policies.

Key Responsibilities

Operational

• Review and assess medical claims for accuracy, completeness, and eligibility based on policy terms, medical guidelines, and coding systems
• Apply comprehensive knowledge of medical terminology, diagnoses, procedures, and coding systems (e.g., ICD-10, CPT) to determine the validity of claims
• Analyse medical records, invoices, and other relevant documentation to assess the appropriateness of reimbursement
• Communicate effectively with healthcare providers, policyholders, and internal teams to gather additional information or clarify claim details
• Adhere to predefined timelines and service level agreements for claims assessment and resolution
• Maintain accurate records of claims processing activities and ensure confidentiality of sensitive information
• Collaborate with internal teams, such as underwriting, finance, and customer service, to address claim-related queries and resolve issues
• Participate in training programs to enhance knowledge of medical coding practices, industry regulations, and company policies

Corporate Governance & Compliance

• Ensure compliance with company policies, procedures, and regulatory guidelines throughout the claims assessment process
• Maintain confidentiality and handle sensitive information in accordance with privacy laws and regulations
• Adhere to ethical standards and conduct while dealing with confidential or sensitive matters
• Stay informed about applicable laws, regulations, and compliance requirements relevant to claims processing

Professional Development & Culture

• Engage in ongoing professional development activities to enhance knowledge and skills in claims assessment, regulatory compliance, and corporate governance
• Foster effective working relationships with internal stakeholders, including underwriting, finance, and customer service teams to ensure alignment and collaboration in claims activities

Location

Nairobi, Kenya