Assistant Director, Claims Management – 2 Posts
Full time @Social Health Authority · SHA posted 3 months ago in Health Care , in Insurance Shortlist Email JobJob Detail
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Job ID 3393
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Offered Salary 1000
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Career Level Others
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Experience 10 Years +
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Gender Both
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Industry Healthcare
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Qualifications masters-degree
Job Description
Assistant Director, Claims Management – 2 Posts
Qualifications, Skills and Experience Required:
Promotional – Claims Management (Medical Review):
- Cumulative service period of twelve (12) years relevant work experience, three (3) of which should have been at the grade of Principal Claims Management Officer or a comparable position.
- Bachelor’s Degree in Medicine and Surgery from a recognized institution.
- Master’s Degree in Medicine and Surgery from a recognized institution.
- A valid practicing license from a recognized institution.
- Certificate in Leadership course lasting not less than four (4) weeks from a recognized institution.
- Proficiency in computer applications.
- Demonstrated managerial, administrative, and professional competence in work performance and results.
Responsibilities:
- Coordinating medical reviews and interpretation of medical reports.
- Coordinating the reviewing, processing, and validating of medical claims from healthcare providers and facilities for accuracy and adherence to policies.
- Coordinating the appraisal of medical claims based on the benefit package to ensure fair and timely disbursement of funds.
- Ensuring issuance of pre-authorizations for access to healthcare services.
- Maintaining and operationalizing an e-claims and case management system.
- Ensuring sensitization of claimants on the consequences of submitting false and fraudulent claims.
- Coordinating the collection and analysis of data for claim management to inform strategic decisions.
- Preparing quarterly reports on claims for submission to the Board and Cabinet Secretary.
- Carrying out any other necessary functions for the Authority’s mandate.
- Coordinating the management of contracted and outsourced claims management services.
- Coordinating quality assurance surveillance to identify gaps and recommend corrective actions.
- Ensuring assessment of quality healthcare providers for declaration, enforcement, and compliance to contractual provisions.
- Establishing systems and controls for detecting and identifying fraud to minimize financial risks.
Applicants must satisfy the requirements of Chapter Six of the Constitution of Kenya by submitting valid and current copies of the following:
- Certificate of Good Conduct from the Directorate of Criminal Investigations.
- Tax Compliance Certificate from the Kenya Revenue Authority.
- Clearance Certificate from the Higher Education Loans Board (HELB).
- Clearance Certificate from the Ethics and Anti-Corruption Commission (EACC).
- Report from a Credit Reference Bureau (CRB).
SHA is an equal opportunity employer committed to diversity and gender equality. Canvassing will lead to automatic disqualification. Only shortlisted candidates will be contacted.
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