Our Client is currently recruiting a Medical Officer (Claims Management)
Job Description:
- Medical Officer has to be well equipped with the latest technologies and therapies emerging into the treatment trends.
- Medical officer has to be alert in analyzing the distinguish between the actual and the fake treatments.
- Medical officer is incumbent for the auditing and monitoring of medical claims related to patient diagnoses, treatments and medications.
- Monitors the list submitted by clinical officer claims to insurance.
- Medical Officer has to analyze Company’s response to claims.
- Regular liaison with insurers, loss adjusters / appointed experts and has to be expert in negotiating.
- Utilizing new Claims repository.
- Assess employee performance.
- Monitor data entry and processing.
- Expert in Developing and implementing latest office policies and procedures.
- Supervise inventory records.
- Provide educational material for patients.
- Preparation and delivery of claims presentations.
- Provide cover for colleagues in their absence, ensuring that the handling of their claims is kept up to date.
- Any other duties as may be assigned.
- Accomplishes department objectives by managing staff; planning and evaluating department activities.
- Accomplishes staff results by communicating job expectations; planning, monitoring.
- Appraising job results; coaching, counseling, and disciplining clinical officers.
- Developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
- Identifying and evaluating trends and options.
- Choosing a course of action; defining objectives; evaluating outcomes.
- Supervising the E-claims.
Key Accountabilities (What you are measured on)
- Monitoring the Maintenance of claims files (paper and repository), ensuring they are up to date.
- Monitoring the Maintenance of diaries/claims tracking systems.
- Supervise accurate record of claim advices, reserve changes and payments.
- Monitor that the payment of claims is made promptly and efficiently.
- Monitor the client satisfaction on regular basis.
- Supervise whether the claims team and client teams are kept apprised of significant claim development.
Minimum Qualifications
- A Bachelor of Medicine and Bachelor of Surgery (M.Bch.B) Degree from a recognized university,
- Completed one (1) year of internship,
- Registration by the Medical Practitioners and Dentists Board of Kenya,
- A current retention certificate by the Medical Practitioners and Dentists Board of Kenya, and
- Professional indemnity provided by a recognized Insurance company.
If you feel you fit the above role, please send your CV only quoting the job title on the email subject to jobs@alternatedoors.co.ke
N.B: We do not charge any fee for receiving your CV in our database nor for interviewing.
Only candidates short-listed for interview will be contacted.
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