Claims Officer

The Aga Khan Hospital, Kisumu is an institution of the Aga Khan Health Service, Kenya, which is an Agency of the Aga Khan Development Network. The Hospital is part of a network of health facilities, which includes Hospitals and Outreach Health Facilities across East Africa. The Aga Khan Hospital, Kisumu is in an exciting growth phase and has attained acknowledgment of its quality by achieving ISO 9001:2015 certification, ISO 15189:2012 accreditation for laboratory services, Safe Care level 5 accreditation and is at advanced stage of attaining Joint Commission International Accreditation. The Aga Khan Hospital, Kisumu has Outreach Health Services at Kisii, Kakamega, Kitale, Bungoma, Kericho, Kibuye-Kisumu, West End- Kisumu, Busia, Homa - Bay, Migori, Bomet, Eldoret, Kimilili and Nyamira. The Hospital is seeking to attract interested and qualified candidates to fill the following position in the Finance Department.

CLAIMS OFFICER

OVERALL RESPONSIBILITY
The successful candidate will be expected to ensure that all corporate client’s claim forms in regard to diagnosis are verified to ensure that the tests and drugs given are in line with the diagnosis for the full settlement of the claims. Will be the link between the Hospital and Corporate clients for any clinical rejections for discussions within the stipulated period and make recommendation regarding uncollectable amounts on the reconciling items. In addition, review all the invoices before dispatch.

KEY RESPONSIBILITIES

Verify and vet Medical Claims for both outpatient and Inpatient claims as per the claims Manual/standard operating procedure. Adhere to customer service charter Manual to ensure compliance to agreed turnaround times. Prompt reporting of any identified risk during claims processing for mitigation. Evaluate Preliminary claim information and revert to corporate clients for more information where applicable. Monitoring of invoices returns and taking appropriate action within a week from the date of return on clinical issues and any query. Take the lead in ensuring the reasons for returns are well addressed to avoid future recurrence. Preparing Rejection analysis on clinical issues and monthly reports as a tool to guide the institution on the status of control. Work with dispatch section to ensure all invoices have been dispatched after Verifications Work with Debtors team to review all the Clinical issues within the reconciliation for signoff for the agreed period with corporate clients. Filing of Claim forms for Diagnosis on reconciliations and maintaining accurate departmental reports on Clinical issues. Facilitate closures to all rejected invoices on medical issues. Participate in all team efforts as departmental needs arise.

The requirements

REQUIREMENTS

Diploma or Degree in Nursing or equivalent. Proficient in MS Office Suite Formal training in customer care or equivalent demonstrated experience A minimum of 3 years’ experience in a busy Hospital or Insurance

Sector

Social Development