JOB PURPOSE

Analyzing of medical claims and to ensure the smooth flow of work in line with the departmental requirements to achieve overall business objectives.

PRINCIPAL ACCOUNTABILITIES

• Ensuring daily recording of incoming medical bills.
• Receiving claims and checking corresponding policies in line with the claim.
• Reconciliation of Medical service providers accounts.
• Registration of claims and reserving adequate estimates.
• Ensuring the ailment is covered under the policy.
• Ensuring the treatment and the drugs dispensed are in line.
• Ensuring the with-holding Tax by Doctors’ is complied with before cheque dispatch.
• Ensuring the appointment of investigators for authenticity of questionable claims.
• Ensuring the facility is registered within the medical practitioners and dentists board.
• Preparing claim notes for vetting by the medical personal and approval/comments by the HOD.
• Ensuring dispatch of discharge voucher to the client and communicating by writing on the liability.
• Ensuring claims are settled within approved company guidelines
• Ensuring proper dispatch of settlement cheques.
• Ensuring that the files are sent back to the filling room.
• Reconciling of claim statements from stakeholders for correct position of their accounts
• Preparing remittances for any Medical claims cheques before dispatch.
• Ensuring proper records of outgoing settlement cheques to various stakeholders.
• Ensuring service providers meet agreed service timeline.
• Ensuring customers service to both internal and external
• And any other duties assigned

MINIMUM QUALIFICATIONS - KNOWLEDGE AND EXPERIENCE

• Undergraduate Degree in any Related Field
• AIIK
• CPA
• At least 2 years of relevant experience

• Ensuring daily recording of incoming medical bills.
• Receiving claims and checking corresponding policies in line with the claim.
• Reconciliation of Medical service providers accounts.
• Registration of claims and reserving adequate estimates.
• Ensuring the ailment is covered under the policy.
• Ensuring the treatment and the drugs dispensed are in line.
• Ensuring the with-holding Tax by Doctors’ is complied with before cheque dispatch.
• Ensuring the appointment of investigators for authenticity of questionable claims.
• Ensuring the facility is registered within the medical practitioners and dentists board.
• Preparing claim notes for vetting by the medical personal and approval/comments by the HOD.
• Ensuring dispatch of discharge voucher to the client and communicating by writing on the liability.
• Ensuring claims are settled within approved company guidelines
• Ensuring proper dispatch of settlement cheques.
• Ensuring that the files are sent back to the filling room.
• Reconciling of claim statements from stakeholders for correct position of their accounts
• Preparing remittances for any Medical claims cheques before dispatch.
• Ensuring proper records of outgoing settlement cheques to various stakeholders.
• Ensuring service providers meet agreed service timeline.
• Ensuring customers service to both internal and external
• And any other duties assigned

• Undergraduate Degree in any Related Field
• AIIK
• CPA