Claims Analyst — Old Mutual Kenya (Nairobi)

Claims Analyst

Overview

Old Mutual Kenya is looking for a Claims Analyst to ensure the accurate and efficient processing of medical claims. This role is focused on verifying documentation, ensuring policy compliance, and identifying abnormal utilization patterns. You will play a critical part in maintaining audit readiness and minimizing financial leakage by ensuring that all inpatient and outpatient claims are captured correctly and processed within agreed turnaround times (TATs).

Responsibilities

• Evaluate inpatient and outpatient medical claims for accuracy, coding correctness, and policy scope.
• Verify member eligibility, pre-authorizations, and SHIF deductions.
• Capture and update claim data into the management system, ensuring all ICD-10 and CPT codes are correct.
• Flag and escalate inconsistent data entries or potential fraud cases to the supervisor.
• Index and organize physical and scanned claim documents for easy retrieval during audits.
• Generate weekly and monthly reports on claim trends, rejections, and approvals.
• Process scheme reversals and corrections for cancelled or wrongly pushed claims.

Qualifications & Experience

• Strong understanding of medical insurance claims processing and policy benefits.
• Proficiency in using claims management systems and MS Office applications.
• High level of attention to detail and ability to work within strict TATs.
• Experience with ICD-10 and CPT coding is essential.
• Analytical mindset with the ability to detect unusual patterns.

Method of Application

Apply via:  Old Mutual Kenya on oldmutual.wd3.myworkdayjobs.com