Position: Claims Administrator (For a Private Medical Insurance Company)
Employer: A Leading Private Medical Insurance Company offering local and international Healthcare Solutions)
Ref No: SGK-CA-02-2020
Job Category: Supervisory
Diploma or Degree in Medical, Insurance, Business Management or other related fields.
At least 3 years hands-on working experience as a Medical Claims Administrator in a busy Medical Insurance department/company
Claim Administrator will perform the following duties:-
Sort, vet & acknowledge receipt of claims received on email from Clients, brokers & providers.
Process and reconcile Aetna direct claims submitted through EHS.
Assist Claims Manager in reviewing all Denials & Part payments for justification.
Assist Claims Manager in lodging reassessments where denials are unjustified.
Assist in claims reporting including claims experience & trends.
Participating in calls with Aetna for efficiency & quality assurance.
Liaison with other internal departments to ensure seamless claims work flow.
Working closely with Network team to flag & prevent fraud and enforce reasonable & customary billing.
Providing leadership, training & mentorship to claims assistants.
Handle general queries from clients, brokers and providers on phone and email and escalate complex cases to Claims Manager.
Expected Salary:- Kshs. 80,000 - 100,000 plus generous benefits