Clinical Officer – Medical Analyst

Health Insurance Company

Job Summary

A clinical officer who will be able to apply their medical expertise in Medical insurance claims processing

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

Job Description/Requirements

We are a company in the in Healthcare Insurance administration industry in Kenya, Currently are sourcing for highly motivated individuals to join our team.  Interested applicants are invited to send their applications detailing current and expected salary and a CV with contact details of three referees by 31st January 2022 by 5pm.

Only shortlisted candidates will be contacted.

We are currently recruiting for one position namely:
1)    Clinical Officer – Medical Analyst

Position    Medical Analyst
Reports to    Team Leader  – Medical Operations   
Level    Executive Level – 2 years’ experience in a busy hospital   

Principle Role     
A clinical officer who will be able to apply their  medical expertise in Medical insurance claims processing

KEY RESPONSIBILITIES AND DELIVERABLES:
•    Responding to pending issues from service providers.
•    Ensuring set targets are met and TAT observed and achieved.
•    Vetting and processing of reimbursements.
•    Process Company’s response to claims/Preauth
•    Monitoring inventory records.
•    Coordination of claims/Preauth processing.
•    Follow up with providers for bills, discrepancies in bills and other information that is holding up processing.
•    Respond to client enquiries on claims through e-mail, phone or directly.
•    Resolve problems related to claims/preauth by liaising with Medical service Providers panel.
•    Clinical officer has to be well equipped with the latest trends and technologies used.
•    Expert in drafting the process in and out.
•    Smart in tackling various types of clients.
•    Supervising the educational material provided to patients by clinical officer.
•    Evaluating the Preparation and delivery of claims presentations by clinical officer.
•    Provide cover for colleagues in their absence, ensuring that the handling of their Preauth/claims is kept up to date.
•    Liaising with other healthcare personnel for efficient delivery of patient care.
•    Responding to mails, calls, and medical related queries on social media platform.
•    Any other duties as may be assigned.   

QUALIFICATION AND EXPERIENCE
•    Minimum Qualifications and Experience Requirements
•    Diploma clinical medicine and surgery.
•    Registered and licensed by the relevant medical body.
•    Minimum of 3 years of experience in relevant medical field
•    Experience in the Health Insurance industry will provide an added advantage
•    Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
•    Knowledge and experience in reading, analyzing, and interpreting reports and support procedures.
•    Proficiency in MS Office - specifically Excel, Access, Word, PowerPoint.
•    Ability to effectively present information and respond to questions from management, peers and customers.
•    Self-driven, customer centric , team player and good communication Skills
•    Willingness to go the extra mile.

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