Medical-Claims-Officer
2025-10-02T08:01:02+00:00
AGC Tenwek Hospital
https://cdn.greatkenyanjobs.com/jsjobsdata/data/employer/comp_8950/logo/AGC%20Tenwek%20Hospital.jpeg
https://tenwekhosp.org/
FULL_TIME
Nairobi
Nairobi
00100
Kenya
Healthcare
Healthcare
2025-10-10T17:00:00+00:00
Kenya
8
The Medical Claims Officer will be responsible for the accurate preparation, processing, and follow-up of all hospital claims to insurance companies, Social Health Authority (SHA), and other third-party payers in line with signed MoUs and contracts. The role ensures claims are properly documented, submitted on time, and reconciled to minimize the hospital’s financial exposure and enhance revenue collection.
Key Responsibilities
Claims Management
- Prepare, review, and submit all hospital claims to insurance companies, SHA, and other contracted third parties within stipulated timelines.
- Ensure claims are prepared in accordance with signed MoUs, contracts, and prevailing guidelines.
- Verify accuracy and completeness of patient information, medical records, coding, and billing before submission.
- Track and follow up on pending claims, rejections, and underpayments to ensure timely settlement.
Documentation & Compliance
- Maintain accurate and up-to-date claims records, databases, and filing systems.
- Ensure adherence to all regulatory, hospital, and insurer requirements.
- Liaise with internal stakeholders (Clinical, Billing, Records, and ICT departments) to resolve claim-related queries.
- Ensure compliance with SHA/insurance reporting and audit requirements.
Financial Accountability
- Reconcile claims submitted versus payments received and highlight variances.
- Identify and escalate financial exposure risks arising from delayed, rejected, or disputed claims.
- Support the Finance Manager in revenue analysis, reporting, and forecasting based on claims performance.
Stakeholder Engagement
- Act as the key contact between the hospital and insurance providers/SHA on claims-related matters.
- Work closely with the Finance Manager to negotiate and review claims settlement processes.
- Provide regular updates and reports on claims status to management.
Qualifications & Experience
- Bachelor’s degree in Finance, Accounting, Business Administration, or related field.
- Diploma in Clinical Medicine & Surgery or Diploma in Community Nursing
- Professional certification in Medical Billing & Coding, Health Economics, Health Management Systems or equivalent is an added advantage.
- Minimum of 3 years’ experience in medical claims management, billing, or healthcare finance (hospital setting preferred).
- Knowledge of Social Health Authority guidelines, insurance claims processes, and hospital billing systems.
How to Apply:
Interested candidates who meet the above criteria should send their applications to recruit@tenwekhosp.org on or before 10th October 2025, enclosing:
- Resume
- Cover Letter
- Statement of Faith
What is a Statement of Faith?
A Statement of Faith should describe your Christian faith and how you see it as relevant to your involvement with Tenwek Hospital. The statement can either be incorporated into the cover letter or submitted as a separate document and should include, at a minimum, a description of your spiritual disciplines (prayer, study, etc.) and your current fellowship or place of worship.
Key Responsibilities
Claims Management
Prepare, review, and submit all hospital claims to insurance companies, SHA, and other contracted third parties within stipulated timelines.
Ensure claims are prepared in accordance with signed MoUs, contracts, and prevailing guidelines.
Verify accuracy and completeness of patient information, medical records, coding, and billing before submission.
Track and follow up on pending claims, rejections, and underpayments to ensure timely settlement.
Documentation & Compliance
Maintain accurate and up-to-date claims records, databases, and filing systems.
Ensure adherence to all regulatory, hospital, and insurer requirements.
Liaise with internal stakeholders (Clinical, Billing, Records, and ICT departments) to resolve claim-related queries.
Ensure compliance with SHA/insurance reporting and audit requirements.
Financial Accountability
Reconcile claims submitted versus payments received and highlight variances.
Identify and escalate financial exposure risks arising from delayed, rejected, or disputed claims.
Support the Finance Manager in revenue analysis, reporting, and forecasting based on claims performance.
Stakeholder Engagement
Act as the key contact between the hospital and insurance providers/SHA on claims-related matters.
Work closely with the Finance Manager to negotiate and review claims settlement processes.
Provide regular updates and reports on claims status to management.
Bachelor’s degree in Finance, Accounting, Business Administration, or related field.
Diploma in Clinical Medicine & Surgery or Diploma in Community Nursing
Professional certification in Medical Billing & Coding, Health Economics, Health Management Systems or equivalent is an added advantage.
Minimum of 3 years’ experience in medical claims management, billing, or healthcare finance (hospital setting preferred).
JOB-68de313ee61f6
Vacancy title:
Medical-Claims-Officer
[Type: FULL_TIME, Industry: Healthcare, Category: Healthcare]
Jobs at:
AGC Tenwek Hospital
Deadline of this Job:
Friday, October 10 2025
Duty Station:
Nairobi | Nairobi | Kenya
Summary
Date Posted: Thursday, October 2 2025, Base Salary: Not Disclosed
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JOB DETAILS:
The Medical Claims Officer will be responsible for the accurate preparation, processing, and follow-up of all hospital claims to insurance companies, Social Health Authority (SHA), and other third-party payers in line with signed MoUs and contracts. The role ensures claims are properly documented, submitted on time, and reconciled to minimize the hospital’s financial exposure and enhance revenue collection.
Key Responsibilities
Claims Management
- Prepare, review, and submit all hospital claims to insurance companies, SHA, and other contracted third parties within stipulated timelines.
- Ensure claims are prepared in accordance with signed MoUs, contracts, and prevailing guidelines.
- Verify accuracy and completeness of patient information, medical records, coding, and billing before submission.
- Track and follow up on pending claims, rejections, and underpayments to ensure timely settlement.
Documentation & Compliance
- Maintain accurate and up-to-date claims records, databases, and filing systems.
- Ensure adherence to all regulatory, hospital, and insurer requirements.
- Liaise with internal stakeholders (Clinical, Billing, Records, and ICT departments) to resolve claim-related queries.
- Ensure compliance with SHA/insurance reporting and audit requirements.
Financial Accountability
- Reconcile claims submitted versus payments received and highlight variances.
- Identify and escalate financial exposure risks arising from delayed, rejected, or disputed claims.
- Support the Finance Manager in revenue analysis, reporting, and forecasting based on claims performance.
Stakeholder Engagement
- Act as the key contact between the hospital and insurance providers/SHA on claims-related matters.
- Work closely with the Finance Manager to negotiate and review claims settlement processes.
- Provide regular updates and reports on claims status to management.
Qualifications & Experience
- Bachelor’s degree in Finance, Accounting, Business Administration, or related field.
- Diploma in Clinical Medicine & Surgery or Diploma in Community Nursing
- Professional certification in Medical Billing & Coding, Health Economics, Health Management Systems or equivalent is an added advantage.
- Minimum of 3 years’ experience in medical claims management, billing, or healthcare finance (hospital setting preferred).
- Knowledge of Social Health Authority guidelines, insurance claims processes, and hospital billing systems.
How to Apply:
Interested candidates who meet the above criteria should send their applications to recruit@tenwekhosp.org on or before 10th October 2025, enclosing:
- Resume
- Cover Letter
- Statement of Faith
What is a Statement of Faith?
A Statement of Faith should describe your Christian faith and how you see it as relevant to your involvement with Tenwek Hospital. The statement can either be incorporated into the cover letter or submitted as a separate document and should include, at a minimum, a description of your spiritual disciplines (prayer, study, etc.) and your current fellowship or place of worship.
Work Hours: 8
Experience in Months: 36
Level of Education: bachelor degree
Job application procedure
Interested in applying for this job? Click here to submit your application now.
Interested candidates who meet the above criteria should send their applications to recruit@tenwekhosp.org on or before 10th October 2025, enclosing:
- Resume
- Cover Letter
- Statement of Faith
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