About this role
Medical Claims Analyst
Fidelity Shield Insurance
- Job Type Full Time
- Qualification BA/BSc/HND , Diploma
- Experience 7 years
- Location Nairobi
- Job Field Insurance , Medical / Healthcare
The key deliverables for the role are;
- Review and assess medical claims for accuracy, completeness, and eligibility based on policy terms, medical guidelines, and coding systems
- Attending to providers, specialists and customer queries by determining their requirements, answering to these inquiries, resolving problems, and ensuring good service as a friendly cost.
- Adjudicating inpatient and outpatient medical claims while verifying the accuracy of information provided.
- Oversee quality control processes and claims assessment, adjudication, payment, and communication
- Monitor the quality of services provided by third-party vendors to ensure contractual obligations and service standards are met.
Qualifications;
- Bachelor's degree or a Diploma in Nursing, Clinical Medicine, Healthcare Management.
- Strong background in medical claims assessment will be a plus including knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and treatment procedures.
- At least 7 years’ of experience in health insurance claims adjudication, with at least 2 year out of those, in quality assurance.
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