Background

Penda Health is an award-winning startup company that is transforming healthcare in East Africa by building a chain of outpatient health clinics that offer evidence-based medical care and unparalleled member experience at surprisingly affordable rates. Penda is ranked the Best Health Care Firm to work for in Kenya and the #26 Best company to work in Kenya.

Role Overview

The Credit Officer reports directly to the Senior Manager, Credit Control and owns the collection and reconciliation of assigned insurance and corporate payer accounts. The role follows submitted claims through acknowledgement, payment, allocation and account sign-off, working with Claims Assistants on submission gaps and the Credit Controller on complex disputes. The role has no line-management responsibility.

Key Responsibilities

Portfolio Receivable Management

• Resolve all queries relating to outstanding accounts from insurance and corporate partners, as well as internal stakeholders, promptly and professionally to support timely collections.
• Investigate and resolve billing disputes and payment queries raised by insurance and corporate partners by coordinating with Medical Centres and relevant internal teams.
• Coordinate regular account reconciliations with assigned partners, ensuring all discrepancies are resolved and reconciliation sign-offs are completed within the agreed timelines.
• Prepare and submit appeals for disputed or rejected claims by obtaining the necessary supporting documentation and justifications from the Medical Billing team.
• Develop and maintain strong business relationships with insurance and corporate partners to enhance collaboration, improve communication, and maximize collections.
• Maintain accurate and up-to-date system records by documenting account activities, payment status, follow-up actions, and partner engagements.
• Drive timely collections for the assigned portfolio through consistent follow-up on outstanding invoices and adherence to agreed credit terms and collection targets.
• Proactively identify and resolve payment bottlenecks by engaging the relevant internal and external stakeholders to accelerate collections and minimize overdue receivables.

Medical Centre Support

• Resolve routine billing and account queries and coordinate missing documentation with Medical Centres and Claims Assistants.
• Record recurring errors and refer training needs to the Senior Manager, Credit Control, seeking Clinical input on coding and medical justification.

Process Feedback & Compliance

• Identify recurring payer-rule and Medical Centre process gaps and submit evidence and training needs to the Senior Manager, Credit Control, who owns all training planning and delivery.
• Process Compliance: Ensure adherence to established credit control procedures, policies, and SOPs in managing customer accounts, collections, and debt recovery.
• Accuracy and Timeliness: Maintain accurate customer account records, ensure timely allocation of receipts, and resolve billing and reconciliation discrepancies promptly.

Reporting

• Send statements by the 6th, submit portfolio ageing and cash forecast inputs by the 8th and complete monthly reconciliations by the 15th.
• Provide weekly collection updates and a monthly dispute register to the Senior Manager, Credit Control, with inputs to the Controller’s consolidated reporting.
• Prepare adjustment and write-off schedules for independent review and approval; process only approved adjustments with Accounting.
• Resolve routine payer queries and appeals within contractual deadlines.
• Maintain claim-level reasons, evidence, action dates and outcomes; refer complex cases to the Credit Controller and material or unresolved risks directly to the Senior Manager, Credit Control.
• Prepare and send statements, reconcile monthly with payer records and obtain quarterly payer sign-offs.
• Track overdue invoices and payment commitments to closure.
• Perform other duties assigned by the Senior Manager, Credit Control within the role’s scope and delegated authority.

Key Performance Indicators

• Monthly collections achievement: cash received on assigned accounts divided by the approved monthly collection target; report recovery of balances over 90 days separately.
• On-time payment rate by value: cash received by the contractual due date divided by the value of claims falling due in the month, using the same definition across the team.
• Monthly reconciliation completion by the 15th and quarterly payer sign-offs for all assigned accounts, with documented exceptions and recovery dates.
• 100% of open payer disputes and missed payment commitments recorded with an owner and next action date, with appeals lodged before contractual deadlines.
• Accuracy & Timeliness:≥98% accuracy in allocations and reconciliations. 100% adherence to stipulated timelines for the different credit functions as stipulated by the Credit SOP.

Culture/ Living the Penda Way

• Foster a collaborative and positive work environment within the team, encouraging teamwork, open communication, and mutual support.
• Collaborate and ensure smooth cross-functional operations and initiatives between the team and other departments.
• Be a great teammate, reliable, consistent.
• Be part of the Penda story and show that by actively helping other departments and processes that helps achieve Penda vision.
• Handle conflict and feedback well and communicate and work with others at Penda well.

Qualifications & Skills

• Bachelor’s degree in Finance, Business Management or related field. CPA is an added advantage.
• 4 years experience in a busy credit department in a healthcare organisation or medical claims underwriting in an insurance company.
• Knowledge of SHA claims, insurance billing and payer reconciliation processes is an added advantage.
• Capable of managing profitability and finding creative solutions addressing financial problems.
• Extremely detail-oriented, efficient, and able to multitask, prioritise, manage and follow projects through to completion.
• Must have high standards of integrity, ethics, and confidentiality.

• Resolve all queries relating to outstanding accounts from insurance and corporate partners, as well as internal stakeholders, promptly and professionally to support timely collections.
• Investigate and resolve billing disputes and payment queries raised by insurance and corporate partners by coordinating with Medical Centres and relevant internal teams.
• Coordinate regular account reconciliations with assigned partners, ensuring all discrepancies are resolved and reconciliation sign-offs are completed within the agreed timelines.
• Prepare and submit appeals for disputed or rejected claims by obtaining the necessary supporting documentation and justifications from the Medical Billing team.
• Develop and maintain strong business relationships with insurance and corporate partners to enhance collaboration, improve communication, and maximize collections.
• Maintain accurate and up-to-date system records by documenting account activities, payment status, follow-up actions, and partner engagements.
• Drive timely collections for the assigned portfolio through consistent follow-up on outstanding invoices and adherence to agreed credit terms and collection targets.
• Proactively identify and resolve payment bottlenecks by engaging the relevant internal and external stakeholders to accelerate collections and minimize overdue receivables.
• Resolve routine billing and account queries and coordinate missing documentation with Medical Centres and Claims Assistants.
• Record recurring errors and refer training needs to the Senior Manager, Credit Control, seeking Clinical input on coding and medical justification.
• Identify recurring payer-rule and Medical Centre process gaps and submit evidence and training needs to the Senior Manager, Credit Control, who owns all training planning and delivery.
• Ensure adherence to established credit control procedures, policies, and SOPs in managing customer accounts, collections, and debt recovery.
• Maintain accurate customer account records, ensure timely allocation of receipts, and resolve billing and reconciliation discrepancies promptly.
• Send statements by the 6th, submit portfolio ageing and cash forecast inputs by the 8th and complete monthly reconciliations by the 15th.
• Provide weekly collection updates and a monthly dispute register to the Senior Manager, Credit Control, with inputs to the Controller’s consolidated reporting.
• Prepare adjustment and write-off schedules for independent review and approval; process only approved adjustments with Accounting.
• Resolve routine payer queries and appeals within contractual deadlines.
• Maintain claim-level reasons, evidence, action dates and outcomes; refer complex cases to the Credit Controller and material or unresolved risks directly to the Senior Manager, Credit Control.
• Prepare and send statements, reconcile monthly with payer records and obtain quarterly payer sign-offs.
• Track overdue invoices and payment commitments to closure.
• Perform other duties assigned by the Senior Manager, Credit Control within the role’s scope and delegated authority.

• Managing profitability
• Finding creative solutions addressing financial problems
• Extremely detail-oriented
• Efficient
• Able to multitask
• Prioritise
• Manage and follow projects through to completion
• High standards of integrity
• High standards of ethics
• High standards of confidentiality

• Bachelor’s degree in Finance, Business Management or related field.
• CPA is an added advantage.
• 4 years experience in a busy credit department in a healthcare organisation or medical claims underwriting in an insurance company.
• Knowledge of SHA claims, insurance billing and payer reconciliation processes is an added advantage.