Assistant Medical Claims Analyst

JOB PURPOSE To evaluate medical claims submitted to the company and determine whether claims meet eligibility standard of the company. • Reconcile provider statements and schedule their payments PRINCIPAL ACCOUNTABILITIES Claims Processing and Provider Reconciliation: Receiving invoices form various service providers and registering them into system. Verifying and auditing all medical claims to ensure supporting documents are attached and following up of documents not submitted with service providers/clients. Accurate capturing of all invoices in the system. Prompt account reconciliation and sign offs with service providers and address all disputes to completion. Recommend appropriate payment of disputed billing as necessary Negotiate and schedule monthly medical payments for approval. Prepare and send payment remittances Prepare monthly claims, reconciliation and sign off reports for the management Customer Service: Respond to client’s queries on telephone, calls, emails and walk in clients. Build and enhance relationship with providers to ensure Pacis Insurance account with the providers is current and active. Ensure adherence to contracts and service level agreements between providers and the company Qualifications: Minimum Academic Qualification: Degree in Business related course / Statistics/ Accounts Professional Qualifications Diploma in Insurance IIK as an added advantage Experience: 1 year experience in claims section of a health insurance department Knowledge: Understanding of insurance industry go to method of application »