Background

Liberty Life Assurance Kenya is a life insurance provider that has been providing relevant products to Kenyans for over 50 years. Our purpose at Liberty is to make a difference in people’s lives by making financial freedom possible. We change realities and make freedom possible by providing innovative and relevant solutions that help our customers prote...

Job Summary

The role holder will be responsible for assisting in risk management through assessing the eligibility of applicants to obtain medical cover, scheme performance analysis, proposal of appropriate renewal terms and scheme administration for those already on medical cover within the set standards of service

Qualifications

Bachelor’s degree in Insurance or business-related discipline

Progress towards Diploma in Insurance (ACII or AIIK), (at least 3 papers or equivalent)

Experience

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

Competencies

Understanding of insurance operations and concepts

Knowledge of insurance regulatory requirements

Knowledge of claims procedures

Excellent organizational and stakeholder management skills

• 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.
• Embrace governance requirements with respect to KYC/AML/Data protection requirements per governing Acts.

• Understanding of insurance operations and concepts
• Knowledge of insurance regulatory requirements
• Knowledge of claims procedures
• Excellent organizational and stakeholder management skills

• Bachelor’s degree in Insurance or business-related discipline
• Progress towards Diploma in Insurance (ACII or AIIK), (at least 3 papers or equivalent)