At Ciala Hospital, we are committed to providing exceptional healthcare services to our patients with compassion, expertise, and the latest medical advancements. With a team of dedicated professionals and state-of-the-art facilities, we strive to be a leading healthcare provider in our community.

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Claims Officer

Job Type

Full Time

Qualification

BA/BSc/HND , Diploma

Experience

3 years

Location

Kisumu

Job Field

Insurance

Qualifications & Requirements

Applicants must meet the following requirements:

Diploma or Degree in Clinical Medicine, Business Administration, Health Records, Finance, or any other relevant business/health-related field

Minimum of three (3) years’ relevant experience in a busy private hospital setting

Strong and proven knowledge of SHA (Social Health Authority) claims processes and other private insurance schemes

Good understanding of hospital billing, pre-authorizations, claim submissions, and reconciliation processes

Experience in handling claim rejections, resubmissions, and follow-ups with insurers

Familiarity with hospital management systems and electronic claims processing will be an added advantage

Strong analytical, numerical, and documentation skills

High level of accuracy, integrity, and attention to detail

Excellent communication and follow-up skills with insurers and internal hospital departments

Ability to work effectively under pressure in a fast-paced environment with strict deadlines

Key Responsibilities

The successful candidates will be expected to:

Process and submit insurance claims accurately and in a timely manner in line with SHA and private insurer requirements

Review patient documentation to ensure completeness and compliance before claim submission

Follow up on pending, rejected, or queried claims with insurance providers

Conduct claim reconciliation and assist in resolving variances between billed and paid amounts

Ensure proper coding and documentation support for all submitted claims

Collaborate closely with clinicians, billing, and finance teams to ensure accurate claim preparation

Maintain organized records of all claims submitted, paid, pending, or rejected

Support pre-authorization processes and verification of patient eligibility where required

Monitor claim performance and provide regular reports on claim status and trends

Ensure compliance with insurance policies, hospital procedures, and regulatory requirements

Check how your CV aligns with this job

• Process and submit insurance claims accurately and in a timely manner in line with SHA and private insurer requirements
• Review patient documentation to ensure completeness and compliance before claim submission
• Follow up on pending, rejected, or queried claims with insurance providers
• Conduct claim reconciliation and assist in resolving variances between billed and paid amounts
• Ensure proper coding and documentation support for all submitted claims
• Collaborate closely with clinicians, billing, and finance teams to ensure accurate claim preparation
• Maintain organized records of all claims submitted, paid, pending, or rejected
• Support pre-authorization processes and verification of patient eligibility where required
• Monitor claim performance and provide regular reports on claim status and trends
• Ensure compliance with insurance policies, hospital procedures, and regulatory requirements

• Strong and proven knowledge of SHA (Social Health Authority) claims processes and other private insurance schemes
• Good understanding of hospital billing, pre-authorizations, claim submissions, and reconciliation processes
• Experience in handling claim rejections, resubmissions, and follow-ups with insurers
• Familiarity with hospital management systems and electronic claims processing will be an added advantage
• Strong analytical, numerical, and documentation skills
• High level of accuracy, integrity, and attention to detail
• Excellent communication and follow-up skills with insurers and internal hospital departments
• Ability to work effectively under pressure in a fast-paced environment with strict deadlines

• Diploma or Degree in Clinical Medicine, Business Administration, Health Records, Finance, or any other relevant business/health-related field