Resolution Insurance Company Ltd is a general insurer offering innovative and responsive insurance solutions. We have learned to adapt in this constantly changing society, and develop comprehensive products that are relevant to our clients. We currently have over 60,000 members in our fold and have partnered with over 500 medical service providers across East Africa; a strong network of hospitals, clinics and doctors.
The Resolution Insurance brand is energetic and trendy. In pursuit of our ambitious growth plan, we are looking to fill the below position in our Medical Claims Department.
Claims Adjudicator – Contractual
Reporting to the Assistant Claims Manager, the Claims Adjudicator’s purpose is to ensure that claims are processed correctly and identify overcharged/fraudulent claims in order to save the company money.
Key Responsibility Areas:
- Analyze claims in details for processing.
- Accurately vet and code valid claims for payment.
- Resolve and reconcile problems related to claims, by liaising with the providers and other relevant stakeholders.
- Identify and prevent fraud instances in the claims process.
- Achieve daily targets as stipulated in the claims policy.
- Maintain the claims timelines as stipulated in the claims policy.
- Timely processing of the claims within the approved matrix levels.
- Timely clearance of all claims batches as stipulated in the claims policy.
- Escalation of non-resolved issues to MSP relations within 7 days of initial contact with MSP.
- Prepare the relevant departmental reports.
- Communicate with clients or MSPs regarding claims.
Qualifications and Experience:
- Diploma in a clinical medicine or Nursing.
- KRCHN or KRN/M Certification.
- At least 3 years relevant experience in health management.
- In-depth knowledge of health management
- Computer skills including knowledge of Microsoft Office.
If you believe you are a team player and would be a valuable resource to this ever growing brand, kindly visit our careers page on www.resolution.co.ke By COB, Monday 22nd April 2019.