This job opening has expired.

Claims Assessor - Reconciliations and Payments Job Vacancy at Jubilee Insurance

Share On:
  • Experience Required:3 Years
  • Total Positions:1
  • Job Type: Full Time
  • Job Category: General
  • Minimum Education: Degree
  • Job Location: Nairobi, Kenya
  • Posted on: August 8, 2023
  • Last Date: August 11, 2023

Job Description

Job Ref. No: JHIL081
Position: Claims Assessor – Reconciliations and Payments

Jubilee Insurance was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa. Jubil ee
Insurance has spread its sphere of influence throughout the region to become the largest Composite insurer in East Africa, handling
Life, Pensions, General and Medical Insurance. Today, Jubilee is the number one insurer in East Africa with over 450,000 clie nts. Jubilee
Insurance has a network of offices in Kenya, Uganda, Tanzania, Burundi, and Mauritius. It is the only ISO certified insurance group
listed on the three East Africa stock exchanges – The Nairobi Securities Exchange (NSE), Dar es Salaam Stock Exchange and Uganda
Securities Exchange. Its regional offices are highly rated on leadership, quality and risk management and have been awarded an AA-
in Kenya and Uganda, and an A+ in Tanzania. For more information, visit
We currently have an exciting career opportunity for a Claims Assessor – Reconciliations and Payments within Jubilee
Health Insurance Limited. The position holder will report to the Senior Medical Accountant and will be based at our Head Office
in Nairobi.

Role Purpose
Evaluate and assess insurance claims, ensuring accurate reconciliation of claims data and timely payment processing. The job
holder will be responsible for analyzing claim information, reconciling claims against policy provisions, verifying payment
calculations, and facilitating the payment process. The role involves collaborating with various internal depart ments and external
stakeholders to ensure efficient and accurate claims reconciliation and payment management.

Main Responsibilities
1. Assess claims to ensure details are captured correctly. Member name, policy details, on the claim form match with invoice details.
Invoiced amounts on invoices, letter of undertaking and other documents submitted are similar in the system.
2. Review of declined and part paid claims.
3. Hold meetings with service providers to discuss clinical issues in a view of aligning with industry practices.
4. Confirm membership validity and benefits before processing claims.
5. Review patients’ history and records to determine cause of disease or disorder and assess if treatment and prescription
recommended correlates with the diagnosis.
6. Confirm that treatment given is in adherence to provider panel rules of eligibility as well as customary and reasonable pricing.
7. Provide training and guidance to team members on emerging issues around claims assessment.
8. Identify fraudulent claims with an aim to reduce claims costs and enable prudent benefit management for members.
9. Advise on any emerging fraudulent trends on providers during adjudication and any other improvements in processing of claims.
10. Respond to service providers queries on any part payments and declined bills.

Corporate Governance
1. Ensure compliance with company policies, procedures, and regulatory guidelines.
2. Maintain confidentiality and handle sensitive information in accordance with privacy laws and regulations.
3. Adhere to ethical standards and maintain professional conduct while dealing with confidential or sensitive matters.
Leadership & Culture
1. Engaging in ongoing professional development activities to enhance knowledge and skills in claims assessment, reconciliation,
payment processing, regulatory compliance, and corporate governance.
2. Foster effective working relationships with internal stakeholders, such as underwriting, claims, finance, and actuarial teams, to
ensure alignment and collaboration in medical accounting activities.
3. Foster a culture of accountability and responsibility within the claims function.
Page 2 of 2
4. Serve as a role model for exceptional customer service and professionalism.
5. Change Management: Assist in driving change initiatives within the claims team and the broader organization. Help team members
adapt to changes and foster a culture of agility and continuous improvement.

Key Competencies
1. Analytical Thinking
2. Attention to Detail
3. Effective verbal and written communication
4. Problem-Solving
5. Customer Focus
6. Compliance Knowledge
7. Time Management
8. Teamwork

1. Bachelor’s degree in nursing
2. Good understanding of the concepts of medical insurance
3. Proficient in the use of Microsoft office suite and packages
4. Proficient in the use of Actisure

Relevant Experience
3 years’ experience in claims assessment in the insurance industry

Skills Required

Interpersonal Skills
Communication Skills

Application Details

This job has expired and application is not allowed

More Jobs in Kenya