Duties & Responsibilities

• Achieve profitability of the medical business through    effective management of the claims function, including claims vetting and rates negotiation with providers.
• Ensure that the company meets its claims payment obligations to contracted service providers within SLAs.
• Ensure proper management of medical service provider credit accounts through monthly reconciliation and sign offs.
• Oversee an efficient claiming process that facilitates easy and convenient access to quality medical care.
• Maintain a structured Chronic Disease follow-up and management program.
• Participate in cash-flow management by ensuring accurate claims projections.
• Ensure prompt recovery of reinsurance and out-of-scope claims.
• Continuous review and maintenance of the panel list of medical service providers.
• Maintain an accurate claims reserving system.
• Maintain cordial relations with medical service providers, intermediaries and clients as key partners of the business through Continuous communication and updates.
• Work together with other departments within medical division to carry out consistent programs on member sensitization and health talks.
• Control management expenses through operational efficiency.
• Participate in product development and innovation initiatives.
• Ensure a well-trained and highly motivated staff in order to achieve set business targets.
• Timely preparation and submission of management reports.
• Commission random and planned forensic audits of medical service providers, medical schemes and individual claimants as needs arise.
• Minimum: Bachelor’s degree in a relevant field such as Medicine (preferred), Insurance, Economics, Commerce.

• Minimum: Bachelor’s degree in a relevant field such as Medicine (preferred), Insurance, Economics, Commerce.

• Attainment of relevant professional qualifications, E.g ACII or IIK Diploma

• At least 5 years’ work experience at a Managerial level in a busy Medical claims department, with a reputable insurance company or HMO.

• Technical competence.
• Excellent presentation and training skills.
• Excellent negotiation skills.
• Excellent communication skills (verbal and written).
• Good analytical and reporting skills
• Listening skills.
• Computer skills
• Leadership skills