Medical Claims Analyst

Reporting to the health care Administrator-Bancassurance, the role holder will be responsible for day-to-day engagement with medical providers to ensure quality healthcare provision to members of medical schemes, processing of claims as per the company medical claims procedure and manual.

Key Responsibilities

• Process claims: Verify and analyzing medical claims as per scheme scope of cover whilst ensuring strict adherence to set guidelines and timelines. 
• Manage Costs: Negotiate rates and discounts and monitor trends
• Reconcile claims: Ensure claims are paid on time and reconcile with estimates
• Follow up on claims: Ensure claims are reimbursed on time, and follow up on outstanding claims
• Maintain records: keep records of claims related documents and payment vouchers and provide information to finance department
• Reports: preparation of utilization reports and other reports as required by member / client
• Communicate with providers: Resolve issues, clarify billing and share information 
• Claim cost: management through enforcement of agreed tariffs, monitoring claims trend and conducting utilization review 
• Compliance - Ensure legal compliance of medical claims data in accordance with the Data Protection Act and any other legislative guidelines. 
• Relationship: Maintain strong working relationship with service providers, Insurance company partners, customers and business stakeholders

The Person

For the above position, the successful applicant should have the following:

• Bachelor’s degree in healthcare related field.
• Professional Qualification in COP will be an added advantage
• A master’s degree in health management or business will be an added advantage
• At least 1 year in claim processing
• At least 1 year claim vetting.
• At least 1 year Provider account reconciliations

The above position is a demanding role for which the Bank will provide a competitive remuneration package to the successful candidate. If you believe you can clearly demonstrate your abilities to meet the criteria given above, please log in to our Recruitment portal and submit your application with a detailed CV.

To be considered your application must be received by Friday 28th March 2025

Qualified candidates with disability are encouraged to apply.

Only short-listed candidates will be contacted.