Job Description Apollo Group (Apollo Investments Limited)was an idea born from the need to harness synergies across the insurance business. Built on commitment, integrity and innovation, it has risen to be one of the leading financial groups in East Africa. Apollo Investments Limited (AIL) includes APA Insurance (Kenya and Uganda). It underwrites General Insurance risks such as Fire, Marine, Aviation, Personal Accident, Motor, Liability, Agriculture, Property, and Micro Insurance. We also underwrite Health Insurance i.e. Corporate, Individual & Family Health Insurance. APA Life Assurance is one of the leading insurance companies in Kenya providing Life Insurance and Pension benefits.SUMMARY Responsible for ensuring claims processes and services meets the established standards to guarantee efficiency, monitor and prepare controls for managing claims costKEY PRIMARY RESPONSIBILITIES Conduct an audit of overall claims settled, placing special attention to high value, repeated visits, and duplicate claims. Check the error rate.Review of STP claims in line with acceptable process agreementIdentify Providers with significant billing irregularities or suspected of fraud and have regular provider engagement issues on billing.Admissions tracking; checking on exaggerated bills, unnecessary admissions or overstay admissions, and doctors’ charges.Enforce claims cost controls e.g. co-payments, discounts, provider restrictions, waiting periodsFrequent claimants, irregular services against MOH clinical standards of serviceHigh average cost providersReimbursement reports review to pick exceptions and cold calling/impromptu visits.Monitor and share reports of TATs for all key claims processes credit, reimbursement claims, discount claims.Identify areas of improvement and scale up the STP process. REQUIREMENTSACADEMIC QUALIFICATIONS Business Related DegreeMedical backgroundRisk / Quality assurance experience will be an added advantage JOB SKILLS AND REQUIREMENTS Team player with strong interpersonal and persuasive skillsGood Communication and interpersonal skillsGood analytical skills and keenness to detailsExcellent Negotiation skills and Effective decision maker PROFESSIONAL QUALIFICATIONS Certificate of Insurance Proficiency or any Insurance-related qualificationsQuality Assurance professional qualification will be an added advantage EXPERIENCE At least 3 years of relevant experience in a busy environment
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