On behalf of client, KaziniKwetu Ltd is looking for Claims Officer - Medical to be based in Dar es Salaam. The desired candidates should have prior work experience in a similar role and should also be dynamic, passionate for their role.
Key Responsibilities:
- Liaise with the hospitals and doctors on prompt submission of the admission summary form, monitor procedures being carried out on patients and see to the general well – being of the patient.
- Assess inpatient medical claims documents for authenticity.
- Data entry for medical claims and underwriting records.
- Vet and process medical claims and underwrite documents for payment/on boarding.
- Respond to client enquiries within 24hrs and ensure claims are processed within 30 days.
- Visit Health Care Institutions around Dar es Salaam to confirm admissions.
- Visiting of Providers outside Dar es Salaam upon allocation of schedule.
- Processing reimbursements
- Negotiate rates with doctors in a bid to maintain medical costs.
- Assist in carrying out verification and medical audit of claims/invoices before settlement.
- Collect feedback from admitted clients on quality and scope of service by the service provider
- Liaise with other medical underwriter for purposes of market surveys and development of new control, standards and products.
Qualifications:
- Diploma in Nursing/Clinical Medicine
- Prior experience in similar position in insurance sector
