Medical Claims Analyst — CIC Insurance (Nairobi)

Medical Claims Analyst

Overview

CIC Africa Insurance (SS) Ltd, a subsidiary of the CIC Insurance Group, is recruiting a highly skilled Medical Claims Analyst for its Head Office. Reporting to the Medical Supervisor for Claims & Care Service Management, the successful candidate will be a critical gatekeeper in the claims process. You will be responsible for the technical vetting of both inpatient and outpatient medical claims, ensuring financial accuracy, identifying potential fraud, and maintaining professional relationships with healthcare service providers.

Responsibilities

• Claims Vetting: Technically vet inpatient and outpatient medical bills and invoices, referring any suspicious or fraudulent claims to the supervisor for further investigation.
• Invoice Processing: Batch outpatient invoices into the system and adjust payable amounts based on vetting findings; reject and return incomplete invoices to providers.
• Provider Management: Negotiate and adjust costs with service providers; reconcile statements of accounts and advise providers on unpaid or underpaid bills.
• Reserve Management: Review claims reserves on a continuous basis to reflect new developments and ensure adequate financial provisioning.
• Customer Service: Promptly and professionally resolve customer queries and complaints related to medical claims.
• Risk Improvement: Recommend risk improvement measures to underwriters based on trends observed during the claims vetting process.

Qualifications

• Education: Bachelor’s degree in a related field or a Diploma in Nursing / Clinical Medicine.
• Professional: Must be a Registered Nurse or Clinical Officer.
• Experience: Minimum of 3 years of relevant experience in medical claims or clinical practice.
• Skills: Strong analytical, negotiation, and problem-solving skills.
• Technical: Proficiency in MS Office and specialized insurance software; sound knowledge of regulatory environments.

Method of Application

Apply via:  CIC Insurance on careers.cicinsurancegroup.com