Job Vacancy for Claims Assessor
We are looking for colleagues who are among the best to make our ambition come alive.
Do you have it in you to make African healthcare leapfrog into the future?
Then do read on.
Position based in: Nairobi
Duration: 1 year contract
Start date: as soon as possible
About Carepay: CarePay Ltd (“CarePay”) is a social venture with the ambition and ability to transform the healthcare sector in Africa through cloud based- and mobile technology.
We are a mobile health exchange where digital payment streams and information are connected to medical data, thus improving quality of care, reducing cost of care and creating transparency and accountability.
Our platform is currently being installed at more than 1300 healthcare providers throughout Kenya, and through it people are able to transfer, receive and pay with health related funds and benefits on their mobile phone.
Our mission is to Connect People to Quality Healthcare, first in Kenya, and then in the rest of Africa.
About the Position: The Claims Assessor will have the responsibility of ensuring that medical claims are vetted and that they meet the set objectives for a given project.
The position will also involve giving detailed reporting on all the general findings from the claims vetted with the aim of improving project outcomes as well as to enhance system functionality.
Key Duties and Responsibilities:
- Verify and analyze all data on claims and to ensure these meet the project objectives as well as payer expectations for the various projects.
- To send back simple yet detailed feedback to the provider team where claims do not meet the project expectations.
- To ensure any general trends or inconsistencies noted are reported to the operations and provider teams.
- Timely re-assessing of claims re-submitted by the providers and ensuring the raised queries are understood and following up with the provider team to ensure they are being resolved.
- Provide support to customer call centre to address medical queries that have been escalated to CarePay.
- • Document and be able to extract and present and or discuss provider practices or disease trends.
- Deliver feedback and training aimed at addressing the trends picked from the claims assessment exercise.
- Help design and take part in some spot checks at Provider premises to ensure medical practices noted on claims can be supported at the Provider facilities.
- Participate in testing and documentation of selected CarePay systems
- Provide brain storms and suggestions on improvement of systems and internal processes.
- Help in preparing any necessary medical or marketing materials
- Collect trends that assist in supporting provider price negotiations.
- To perform any other duties as assigned by the supervisor
Educational Qualifications, Knowledge & Experience:
- Degree in Nursing or other suitable medical background or other closely related field
- Good understanding of private and public healthcare delivery.
- Have strong understanding of medical treatments protocols and cost effective prescribing habits in relations to market segmentation.
- At least 2 years’ experience in claims assessing in the medical insurance industry.
Key Skills and Competencies:
- Good analytical and problem solving skills
- Excellent oral and written communication skills
- Proficient administrative and organization skills
- Strong interpersonal skills with ability to work with cross cultural and diverse people and teams
- Collaboration and team working skills
- Customer service skills
- Data Entry skills with ability to produce accurate work
- Reporting and good attention to details
- Ability to prioritize and work to deadlines
- Competent in the use of Microsoft Office applications including word processing and spreadsheets
- Flexible and ability to adapt or change to new situations and handle high levels of uncertainty
- Ability to maintain confidentiality
- Personal qualities of integrity, credibility, professionalism and a commitment to CarePay’s mission.
How to Apply:
If you meet the requirements of this position, apply by sending a Cover Letter explaining briefly how you meet the criteria for the position and updated CV to: recruitment@carepay.co.ke quoting the position in the email subject matter.
The deadline for application is 29th May 2015.
We regret that only short listed candidates will be contacted.