Job Vacancies at APA Life Assurance Company Ltd

Job description

Responsible for ensuring claims processes and services meets the established standards to guarantee efficiency, monitor and prepare controls for managing claims cost

KEY 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 agreement
• Identify 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 periods
• Frequent claimants, irregular services against MOH clinical standards of service
• High average cost providers
• Reimbursement 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.

ACADEMIC QUALIFICATIONS

• Business Related Degree
• Medical background
• Risk / Quality assurance experience will be an added advantage

JOB SKILLS AND REQUIREMENTS

• Team player with strong interpersonal and persuasive skills
• Good Communication and interpersonal skills
• Good analytical skills and keenness to details
• Excellent Negotiation skills and Effective decision maker

PROFESSIONAL QUALIFICATIONS

• Certificate of Insurance Proficiency or any Insurance-related qualifications
• Quality Assurance professional qualification will be an added advantage

EXPERIENCE

• At least 3 years of relevant experience in a busy environment

Claims Analyst

Job description

To ensure prompt and fair settlement of all medical claims in accordance with the claims manual and guidelines in order to control claims expenditure and also maintain a good working relationship with service providers

KEY PRIMARY RESPONSIBILITIES

• Vetting and analyzing medical claims as per the scope of cover whilst ensuring strict adherence to set guidelines and TAT
• Monitors service providers’ claims through analytics in view of ensuring they maintain high standards of service delivery
• Reconciliation of medical providers’ bills & accounts on an ongoing basis or on-demand including visits to providers to sort out contentious bills/ issues

ACADEMIC QUALIFICATIONS

• Diploma in Kenya Registered Community Health Nursing/ Clinical medicine/ pharmacy and/ or in any medical-related qualifications.

JOB SKILLS AND REQUIREMENTS

• Computer literate and familiar with high processing speed using standard office software applications
• Team player with strong interpersonal and persuasive skills
• Good Communication and interpersonal skills
• Good analytical skills and keenness to details
• Excellent Negotiation skills
• Effective decision maker

PROFESSIONAL QUALIFICATIONS

• Certificate of Insurance Proficiency or any Insurance-related qualifications

EXPERIENCE

• At least 3 years’ experience in a busy health Insurance environment with a Claims Vetting & Care management background