The overall responsibility is vetting and authorizing claims to ensure policy guidelines are followed for the respective products with the end result of business profitability and customer satisfaction. Vetting of all claims to ensure that they are within scope of cover for the various provider and member claims.Generate provider claim analysis reports and make recommendations to management on areas of improvement as required.Ensuring all claims returns are done within agreed timelines on a weekly basis.Preparing claims reports and any other report that may be assigned thereof.Ensure all claims for service providers are ready for payment within the set timelines for the specified providers.Monthly service provider reconciliations through the claims supervisor assigned within agreed timelines. File and submit service provide claims returns in good time as per the set guidelines. Enhance relationship with medical service providers to ensure all insured members access services seamlessly. Deal with doctor fees and hospitalization invoices for employees in international companies and intergovernmental institutions.Analyse reimbursements according to the contract agreements and assess, code and calculate them using a computerized claims processing system.Communications to the communication team to solve or preempt any possible issues with your stakeholders.Keep my knowledge up to date with respect to the medical information necessary for handling claims and take part in trainings to ensure you are up to date with policies, processes and other required information.

The overall responsibility is vetting and authorizing claims to ensure policy guidelines are followed for the respective products with the end result of business profitability and customer satisfaction. Vetting of all claims to ensure that they are within scope of cover for the various schemesGenerate outpatient claim analysis reports and make recommendations to management on areas of improvement as required.Responding to queries raised by service providers and customers within 24 hours.Facilitation of service provider reconciliations through the claims supervisor.Ensuring all claims returns are done within agreed timelines on a weekly basis.Preparing claims reports and any other report that may be assigned thereof.Ensure all claims for service providers are ready for payment within the set timelines for the specified providers.Monthly service provider reconciliations through the claims supervisor assigned within agreed timelines. Enhancing good relationship with service providers through excellent customer service.File and submit service provide claims returns in good time as per the set guidelines. Enhance relationship with medical service providers to ensure all insured members access services seamlessly. Processing member’s reimbursements.Attend to providers concerns on both emails and walk in providers.

Attached to the Claims life department to assist in the analyzing processing life claims for full maturities, partial maturities, Surrender value, Death Claims, loans and Policy cancellations.Monitoring liability claims from start to finish, verifying and updating information on submitted claims, reviewing the policy to determine which charges are eligible for reimbursement, reconciling a claims adjuster's estimates, negotiating payment to all parties and following up to ensure all payments are made.Process all claims with bank/ Mpesa details through EFT & MFTPrepare monthly lists for all check-offs notifying them of their members whose policies have maturedPayment of Claims by the due date/ as per TAT and analyze Full maturities due per product, branch and institutionEnhance the strategic role in Life Division’s performance and overall company profitability,Renewed focus on service delivery thus enhancing our role as strategic partners to marketingImprove Customer retention and satisfaction through adherence to TAT, in claims processing, payments and addressing customer complaints.Run the full maturity listing by last working day of every month.Ensure automation of all claims processes (Our role – Highlight areas that are not automated, perform tests and communicate errors)Attach Brochures (for BYK, HEKIMA MMP,UNIPLAN) while sending the Discharge Vouchers for maturing policies claims, reviewing the policy to determine which charges are eligible for reimbursement, reconciling a claims adjuster's estimates, negotiating payment to all parties and following up to ensure all payments are made.

Process and ensure timely settlement of pension claimsEnsure schemes operate effectively and meet performance; quality and customer care targets as well as comply with the industry standards.Calculate the performance and value of fundsKeep up to date with the current statutory regulations and monitor changes in the legal situation for pensions in order to ensure the optimum performance of the fundProvide up-to-date reports to trustees and pension managersDevelop communication strategies to promote the benefits of pension schemesMake recommendations to improve the scheme in response to member feedback and scheme performance.