Claims Vetting and Processing Officer

About the Role

To fulfil promises and obligations of risks assumed by the company on behalf of its clients. It entails critical analysis of claims intimated and making sure ONLY valid claims are paid. Detection of fraudulent claims is key in minimizing claims costs and keeping loss ratios low. To accurately assess, costs contain, process invoices in a timely manner for efficient service delivery

Key Responsibilities

• Vetting and audit of provider invoices before payment to ensure that they are valid and within the policy.
• Vetting and processing of allocated provider invoice payments within agreed timelines.
• Cost management by adhering to CIC contracted rates and guidelines.
• Advising the client/service providers on exclusions and non-payments within accepted time frame.
• Monitor policy claims experience trends and provider trends for escalation to provider management and client retention team for action and resolution.
• Enhance system processes relating to claims vetting and payment processing
• Responding to queries on payments to providers and members
• Negotiation with service providers for discounts and keeping record to include savings earned
• Participate in account reconciliation and sign off of allocated service providers to avoid interruption of services to insured members.
• Work on and share relevant claims reports as may be requested by the Assistant Manager.
• Participate in planning and budgeting for the department.
• Support all medical business events in both for internal events and those involving CIC stakeholders and /or the general public;
• Participate in various meeting and committees
• Any other duty as may be given by the Assistant Manager Claims Vetting & Audit

Who We’re Looking For

Essential Knowledge/Skills and Experience Required:

• Bachelor of Science in Nursing.
• KRN, KRCHN, Clinical Medicineis an added advantage.
• Minimum of 1 year of experience.