Medical Claims Analyst in Nairobi Municipality, Kenya

Banking / Financial Services
Health, Wellness and Fitness
Minimum Qualification
Required Experience
3 - 5 years
Employment Type
Full Time
Male or Female
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Job Description

Reporting to the Healthcare 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 as well as analysis of medical bills submitted for settlement.


Vetting and analysing medical claims as per scope of cover whilst ensuring strict adherence to set guidelines and TAT

Preparation of members’ reimbursement claims and payment of the credit medical providers

24 hour on-call services in management of medical scheme issues

Preparation of utilization reports and other reports as required by member / client

Maintenance of the filing of the medical schemes data/ payment vouchers to ensure proper record keeping

Reconciliation of medical providers’ bills & accounts on an ongoing basis or on demand including visits to providers to sort out contentious bills/ issues

Updating staff medical statements and ensuring all utilizations are captured on a timely basis

Arranging for emergency evacuations for medical scheme members country wide

Professional assistance to all the staff members/dependants with Chronic ailments and facilitating follow up in specialists’ clinics.


Diploma in Kenya Registered Community Health Nursing nursing/ clinical medicine/ pharmacy and/ or in any medical related background i.e. Pharmacy, medical laboratory or clinical medicine

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

Training in Basic and Advance Life Support

Computer literate and familiar with high processing speed using standard office software applications

Mature, team player with strong interpersonal and persuasive skills

Good planning and organization skills with the ability to deliver effectively under strict deadlines

Excellent Listening and Communication skills

Accuracy and attention to detail

Ability to develop working relationships with a wide range of internal and external partners

Maintaining strict confidentiality and integrity of all information he/she comes across in the execution of their duties

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