OVERALL PURPOSE OF THE JOB

The role holder will be based in the Investigations Department and will support the doctor(s) in the analysis of medical claims arising from road traffic accidents. The individual will also play a key role in providing second medical opinions on the nature and extent of injuries sustained.

KEY ROLES AND RESPONSIBILITIES

• Research and report writing pertaining to the confirmation of diagnosis made and treatments administered with claims and reporting on the same.
• Submission of authenticated reports
• Authentication, Analysis, Interpretation and verification of medical treatment records pertaining to accident claims.
• Identification of inconsistency between police and hospital records
• Responsible for highlighting misdiagnosis and / or irregular medical records.
• Preparation of medical reports and statistics.
• Understanding of medical health facility procedures and medical records.
• Re-examination of road traffic accident victims in order to provide a second opinion.
• Any other responsibilities will be communicated to the Officer from time to time
• Giving intelligence of fraud perpetrated in medical facilities
• Identify and report fraudulent activities and fraudsters within the medical facilities

PERSON SPECIFICATIONS

Academic Qualifications

• Bachelor’s Degree in Nursing or its equivalent from a recognized institution
• KRCHN/KRN-Diploma in Nursing

Professional Qualifications

• KRCHN Registered with Nursing Council of Kenya and must possess a valid license
• Member of a relevant professional body

Experience

• Must have at least two (2) years’ working experience in a busy hospital facility.
• Working experience in the insurance industry is an added advantage.

Skills and Attributes

• Basic MS office skills
• Strong interpersonal, communication and negotiation skills
• Superior analytical and report writing skills.
• High moral and ethical standards with independence of mind and ability to defend his/her position on significant issues.
• Excellent word processing and IT skills, Ability to work under pressure and meet tight deadlines
• Good organisational and time management skills
• Ability to research, digest, analyse and present material clearly and concisely
• Ability to take initiative and pay attention to detail High level of integrity and reliability
• Flexibility and adaptability to juggle a range of different tasks and to work extra hours to meet deadlines.
• Discretion and an understanding of confidentiality issues

• Research and report writing pertaining to the confirmation of diagnosis made and treatments administered with claims and reporting on the same.
• Submission of authenticated reports
• Authentication, Analysis, Interpretation and verification of medical treatment records pertaining to accident claims.
• Identification of inconsistency between police and hospital records
• Responsible for highlighting misdiagnosis and / or irregular medical records.
• Preparation of medical reports and statistics.
• Understanding of medical health facility procedures and medical records.
• Re-examination of road traffic accident victims in order to provide a second opinion.
• Any other responsibilities will be communicated to the Officer from time to time
• Giving intelligence of fraud perpetrated in medical facilities
• Identify and report fraudulent activities and fraudsters within the medical facilities

• Basic MS office skills
• Strong interpersonal, communication and negotiation skills
• Superior analytical and report writing skills.
• High moral and ethical standards with independence of mind and ability to defend his/her position on significant issues.
• Excellent word processing and IT skills, Ability to work under pressure and meet tight deadlines
• Good organisational and time management skills
• Ability to research, digest, analyse and present material clearly and concisely
• Ability to take initiative and pay attention to detail High level of integrity and reliability
• Flexibility and adaptability to juggle a range of different tasks and to work extra hours to meet deadlines.
• Discretion and an understanding of confidentiality issues

• Bachelor’s Degree in Nursing or its equivalent from a recognized institution
• KRCHN/KRN-Diploma in Nursing
• KRCHN Registered with Nursing Council of Kenya and must possess a valid license
• Member of a relevant professional body