Skills Geographic

Claims Administrator (For a Private Medical Insurance Company)

Job Summary

Claims Administrator will sort, vet & acknowledge receipt of claims received on email from Clients, brokers & providers.

  • Minimum Qualification: Bachelor
  • Experience Level: Mid level
  • Experience Length: 3 years

Job Description

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

Industry: Insurance

Job Category: Supervisory

Town: Nairobi

Country: Kenya


Qualifications:

Diploma or Degree in Medical, Insurance, Business Management or other related fields.


Experience:

At least 3 years hands-on working experience as a Medical Claims Administrator in a busy Medical Insurance department/company


Responsibilities:
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


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