Place: Dar es Salaam
MEDICAL CLAIMS OFFICER
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
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