At Stratostaff we design, implement and manage workforce solutions for large, specialized or routine staff complements giving you the opportunity to focus on your core business.At Stratostaff we design, implement and manage workforce solutions for large, specialized or routine staff complements giving you the opportunity to focus on your core business.

Profile Introduction      

Our client, a leading financial and health insurance company seeks to bring on board an Claims Analyst. The role will be responsible for processing medical claims with a focus on accuracy, cost containment, risk management and customer excellence.

Key Areas of Responsibility

• Review, assess, authenticate and capture outpatient and inpatient claims as per the claims manual and within the set TATs
• Timely scanning, barcoding and batching of received claims
• Processing of reimbursements within the set TATs
• Conduct quality assurance process before batches are authorized for pay run
• Notify brokers and clients of pended and declined claims within set timelines
• Manage pended and declined claims
• Liaise with agents, brokers and service providers on matters arising on claims
• Ensure all claims documents are archived in the relevant systems
• Maintain claims production within set targets
• Generate daily health claims status report
• Storage of all correspondence in Medware system
• Monitoring and processing of NHIF enhanced benefits for cost containment
• Recording and monitoring of roaming and counter-guarantee claims.
• Customer service – address clients’ queries in form of telephone queries, letters, emails and walk –in clients.
• Maintain proper department standards, discipline and confidentiality regarding patients’ illness

Requirements

Minimum Qualifications:

• Bachelor’s degree/ Diploma in medical, insurance or business-related discipline
• Progress towards Diploma in Insurance will be an added advantage.
• 1 years’ experience in medical claims management in insurance/hospital setting

Core Competencies

• Knowledge of insurance concepts
• Knowledge of medical claims processes and procures
• Knowledge of insurance regulatory requirements
• Stakeholder management
• Customer service
• Good Microsoft Excel skills and math aptitude
• Delivering results and meeting customer  expectations
• Interpersonal skills
• Planning and organizing
• Presenting and communicating information
• Persuading and influencing
• Supervisory skills.
• Adhering to principles and values.