Assistant Health Claims Officer

Reporting to the Assistant Claims Manager, the incumbent will be responsible for customer satisfaction by increased personal contact with clients in hospital and reduce turnaround time in processing of medical claims and enhance cost effective care of insured members. Posting reimbursements and service provider invoices into the Mashinani System. Maintain close contact with appointed health care service providers to ensure strict compliance with agreed procedures, guidelines and service level agreements. Ensure that healthcare providers have adequate claim forms to serve members. Carry out vetting and verification of outpatient and inpatient claims as per claims vetting guidelines.

Ensure that the panel of doctors is strictly adhered to by clients and hospitals in order to reduce claims costs. Negotiate rates for procedures and services to maintain affordable costs for health care services. Managing the Nairobi service providers panel – additions and deletion of providers accordingly. Approval of emails and pre-authorizations within 24 hours for scheduled requests and promptly for emergency approvals. Assess medical claims documents for authenticity and process payments within set service levels. Maintain accurate records on medical claims, send out payment remittances to providers and manage Nairobi provider’s reconciliation of accounts.

Carry out hospital visits for insured members admitted hospitals and manage patient length of stay accordingly. Manning of the 24-hour helpline. Update the required reports. Bachelor’s degree in Nursing or Clinical Medicine. Diploma in insurance - completed or in progress, will be an added advantage. Proficiency in computer/software packages, e. g. , Microsoft Word and ExcelStrong interpersonal skills and ability to work in a team-oriented and collaborative environment;Confident, articulate, and with strong communication skills. Primary LocationSouth Sudan-Juba-JubaJob LevelEntry LevelJob TypeContractualShiftDay JobContract TypeFull-timeTravelNoJob Posting22-08-2025Unposting DateOngoingNumber of Openings1