JOB PURPOSE

The Claims Vetting officer will safeguard the company’s revenue by ensuring the following: that all physical claims and online billing platforms reflect the correct documentation, data input and attachments to support the claim including Diagnosis, claim forms, billing amounts, member details, and benefit utilization by ensuring that all insurance guidelines on scheme have been followed to ensure adherence to SLA as per contract for all insurance, corporate and NHIF billings.

 MAIN DUTIES AND RESPONSIBILITIES

• Perform review of patient identification documents for authenticity.
• Ensure all the required claim documents are filled in by patients and doctors for forwarding to the insurance and the correct documentation is reflected on all online platforms.
• Confirm complete processing of all outpatient and inpatient documents received before dispatch.
• Liaise with other departments in resolving problems with respect to invoices, claim documentation and online billings.
• Ensure completeness and accuracy of claims and invoices (ensuring pre-authorization and/or LOU, signing by the doctor and client claim and bill, presence of diagnosis, co-pay and clear case notes and discharge summary, membership/policy number, claim is within the limit) and presence of smart reports and off smarts where applicable.
• Ensure all IDS (Internal Dispatch Summary Reports) are acknowledged via signing and a copy scanned and filed.

REQUIREMENTS

MINIMUM  QUALIFICATIONS

• Bachelor’s in business administration -Finance option/ Higher Diploma in Business Administration- finance option or its equivalent.
• CPAK/CCP Professional
• Proficiency in MS Office Suite (Excel, Word, and PowerPoint).
• 2-3 Years’ experience in handling claims in a busy hospital.

KEY JOB REQUIREMENTS

• Honesty, transparency, and integrity
• Excellent customer service skills.
• Effective communication skills – listening, oral and written.
• Good interpersonal skills and a team player.
• Ability to work under pressure with minimum supervision.
• Analytical and decision-making skills.
• Report writing and presentation skills.
• Desire for personal development, improvement, and learning.