Oasis Healthcare Group

Job Purpose:

To manage the end-to-end process of submitting and following up on insurance claims to ensure timely and accurate reimbursement to the hospital.

Key Responsibilities:

• Prepare, verify, and submit accurate inpatient and outpatient insurance claims to various insurers (NHIF, private, corporate) within stipulated timelines.
• Follow up on unpaid and rejected claims, communicating with insurers to resolve discrepancies.
• Reconcile claim payments received against amounts billed.
• Maintain detailed records of all claims, rejections, and payments.
• Liaise with clinical staff to ensure necessary documentation (e.g., discharge summaries, investigation reports) is complete for claim submission.
• Verify patient insurance eligibility and benefits at admission.
• Generate reports on claims status, aging analysis, and recovery rates.

Qualifications & Experience:

Education: Diploma or Degree in Insurance, Finance, Business Administration, or a related field.

Experience: Minimum of 2 years of experience in a claims processing role, specifically within a hospital or insurance company.

Key Competencies:

• Strong understanding of insurance principles, policies, and claim procedures.
• Excellent attention to detail and numerical accuracy.
• Strong negotiation and follow-up skills.
• Ability to work with deadlines and handle pressure.

• Prepare, verify, and submit accurate inpatient and outpatient insurance claims to various insurers (NHIF, private, corporate) within stipulated timelines.
• Follow up on unpaid and rejected claims, communicating with insurers to resolve discrepancies.
• Reconcile claim payments received against amounts billed.
• Maintain detailed records of all claims, rejections, and payments.
• Liaise with clinical staff to ensure necessary documentation (e.g., discharge summaries, investigation reports) is complete for claim submission.
• Verify patient insurance eligibility and benefits at admission.
• Generate reports on claims status, aging analysis, and recovery rates.

• Strong understanding of insurance principles, policies, and claim procedures.
• Excellent attention to detail and numerical accuracy.
• Strong negotiation and follow-up skills.
• Ability to work with deadlines and handle pressure.

• Diploma or Degree in Insurance, Finance, Business Administration, or a related field.