Dorcas A. Email & Phone Number

Nairobi

Key responsibilities: • Offer excellent customer service, by managing customer’s database accounts through processing claims within the guidelines to ensure proper record keeping and dissemination. • Ensure quick response to clients in regards to outpatient pre-authorization by offering letters of undertaking through our service providers and maintaining cordial relationships. • Prompt response to customer enquiries regarding claims and preauthorization’s via telephone, always in a professional & efficient manner. This has been constantly achieved by managing our 24 hour helpline.• Assess medical claims documents and ensure timely capturing of out-patient claims payments within the service levels Agreement to minimize customer queries and complaints.• Handling of medical claims/documents with efficiency and maintaining accurate records on medical claims and maintain confidentiality.• Enforce centralized and concise recording of pending membership issues for underwriters action to enable smooth running of claims processing within the department.• Advice clients on the utilization reports upon request.• Respond to brokers, intermediaries, contact persons and providers on issues regarding our client’s claims e.g. pre-authorizations, reimbursement claims reconciliations and utilization reports.• Coordinate with care managers on admission and discharges when notified by the client or medical providers while on call.• Verification of already captured claims for approval of payment by finance.• Team Leader - Overseeing Data enrichment process in readiness for the new system, by coordinating with intermediaries to provide the required information for data based on the know your client (KYC).

Nairobi

Key responsibilities• Posting of membership details into the AIMS system.• Assess medical claims documents for authenticity and process payments within set service levels. • Ensure claims are posted within 14 days of receipt.• Respond to client queries on any issues raised within scope of the job.• Ensure timely receipt of claims and adherence of the smart cards.• Assist with verification• Offer excellent customer service

Kenya

Key responsibilities: • Scanning and attaching all the claims received into the system ready for processing.• Capture claims into the system and forward the claims to Goodhealth Dubai for payment.• Prepare daily reports of claims processed.• Handles outgoing claims, email the already processed claims with the attachment to Good health Dubai, and then forward the physical claims through courier accompanied by the list of all claims sent through email to Dubai.• Receive cheques from Dubai and prepare the settlement letters for the fully paid, partly paid, and rejected to accompany the cheques to providers and clients. Check that partially paid claims go with the letters giving details of the items rejected.• Prepare a list of the cheques ordered and cheques received from Goodhealth Dubai.• Present a weekly follow up report on pending claims, especially claims of over 30 days outstanding.• Coordinate with Good health regarding queries and further clarification on outpatient claims.

Nairobi

Key responsibilities:• Office administrative assistance, handling claims queries from clients and provider, coordinating claims related queries and respond to clients appropriately.• Accurately screen and generate all written and telecommunication both routine and as directed on a daily basis ensuring confidentiality and high professional standards at all times. • Word process account reconciliation letters/reports and queries related to payments/partly payments and send to providers. • Coordination of claims related inquiries, track and return to providers all incomplete claim documents.• Compile weekly report for non eligible invoices in the system and prepare weekly and monthly payment reports to help on cash flow.• Track cheques from printing-approval-signing- dispatch, using the shared cheque dispatch file. Ensure cheques are approved, signed and dispatched on time to providers and clients• Prepare report of all unreleased cheques and forward to the claims manager.• Manage the monthly cheques courier report to ensure that it tallies with our hard copy cheque dispatch record.• Ensure stationery control is in place ,file and update filing systems• Schedule claim department meetings and take minutes of the meetings. • Claims processing, posting of membership details into the system.• Assess medical claims documents for authenticity and process payments within set service levels.• Maintain accurate records on medical claims and filing of processed invoices• Ensure claims are posted within 14 days of receipt.• Respond to client queries on any issues raised within scope of the job.• Offer excellent customer service• Counter checking of processed invoices for approval

Bachelor'S Of Business Management, Risk And Insurance Mgt Option

Diploma In Business Management, Business Administration, Management And Operations