Job purpose: 
The role holder will be responsible for Medical Accounting including Fund management, general ledger reconciliations, premium collections, provider reconciliations and ensuring that provider payments are made on time.

Key responsibilities:

Payments and Reconciliation:

• Prepare monthly hospital pay out targets for major providers and send the list to Medical Claims Team.
• Generate and send remittance advises for payments made to the respective medical providers including with the invoice details.
• Review pay outs on a regular basis with an aim of ensuring that monthly pay out targets for major providers are met.
• Perform reconciliations with provider statements, ensure resolution of outstanding balances on a timely basis and obtain clearance letters from providers.
• Reconcile Britam Credit account facilities with the various providers and ensure the same are maintained within the agreed SLAs.
• Monitor medical provider guarantees ensuring timely renewal of expired guarantees and cancellations for discontinued providers.
• Negotiate for provider efficiency discounts & annual volume discounts.
• Facilitate recoveries on payments above average.
• Delegated Authority:  As per the approved Delegated Authority Matrix.

Fund & Insured Schemes Management:

• Monitor utilization of funded schemes and follow up on replenishment at 75% utilization.
• Generate and issue monthly fund utilization statements and Insured schemes on request.
• Advise cashier on the receipting and allocation for all medical collections including; Insured premiums, Funded schemes and card costs.
• Perform monthly reconciliation of funded schemes and agree balances to ERP

General Ledger Out Patient fund account: 

• Generate Insured premium statement and facilitate collection of the same with the Sales team and intermediaries.
• Reconciliation and collection/recovery of medical claims paid outside policy.
• Process medical premium refunds to clients.
• Prepare monthly reports on provider reconciliation status on reconciliation, discounts, sign off & clearance.
• Ensure all service providers are etims complaint.

General Ledger Reconciliations:

• Prepare monthly reconciliation of general ledgers assigned and pass any adjusting entries to ensure accuracy of amounts reported.

Knowledge, experience and qualifications required:

• Bachelor’s degree in a business related field.
• CPA(K) or other similarly recognized accounting profession qualification.
• 2-3 years of accounting experience in a similar role.
• Knowledge of ERP AP system and/or experience of using Oracle Financials would be an advantage.
• Strong  computer and business solutions software skills.
• Strong analytical and problem solving skills.
• Analytical skills.

Technical/ Functional competencies:

• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Sales and marketing management skills.