Job Title: Claims Officer
Hiring Organization: International
Rescue Committee
Location – Locality: Nairobi
Location – Region: Kenya
Industry: Not For
Profit
Job Type: Full
Time
Salary: KES
Competitive
Date Posted: 02/26/2024
The SHIF Claims Officer at IRC Kenya plays a pivotal role in managing and overseeing the processing, documentation, and submission of claims to the Social Health Insurance Fund. The incumbent will ensure accurate and timely processing of claims, adherence to SHIF guidelines, and effective communication with stakeholders to facilitate reimbursement and improve healthcare service delivery.
Key Responsibilities:
Claims
Processing:
Manage
the end-to-end process of SHIF claims, ensuring accuracy and completeness of
documentation.
Review
and verify claim forms and supporting documents submitted by healthcare
facilities or beneficiaries.
Input and
maintain accurate data related to claims in the designated systems or
databases.
Continuous
follow up the claims submitted to SHIF to ensure timely reimbursement of the
claims.
SHIF
Guidelines Adherence:
Stay
updated with SHIF policies, regulations, and guidelines to ensure compliance in
claims processing.
Interpret
and apply SHIF rules appropriately while processing claims to prevent
discrepancies or rejections.
Documentation
and Record-Keeping:
Maintain
organized and comprehensive records of all claim-related documents, ensuring
confidentiality and accessibility as per organizational policies.
The claim
officer will be required to provide the finance department with accurate
information regarding the claims submitted to SHIF for reimbursement to be
captured into the financial system.
Prepare
accurate reconciliation of claims report against the funds received bi-weekly
and submit to Finance Officer for review. Ensure that all outstanding
claims/discrepancies are followed and settled immediately.
Continuous
liaison with Finance department for confirmation of receipt of funds from SHIF
to enable you perform the reconciliation report.
Generate
and prepare reports on claim processing activities for internal audits or
reporting purposes.
Communication
and Coordination:
Liaise
with healthcare providers, beneficiaries, and SHIF representatives to resolve
any claim-related queries or discrepancies.
Collaborate
with internal teams such as finance, administration, and program staff to
facilitate seamless claim processing.
Quality
Assurance:
Conduct
regular audits on processed claims to ensure accuracy, compliance, and
alignment with SHIF regulations.
Identify
areas for process improvement and contribute to the development of streamlined
claim processing procedures.
Minimum
Qualifications:
Bachelor’s
degree in Business Administration or Accounting, or related field and 2 years’
experience in claims processing or Diploma in either accounting or business
administration with 5 years of experience in processing claims.
In-depth
knowledge of SHIF policies, procedures, and regulations.
Strong
analytical skills with attention to detail and accuracy in documentation.
Proficiency
in using relevant software and databases for claims processing.
Excellent
communication skills (verbal and written) with the ability to interact
effectively with diverse stakeholders.
Ability
to work independently, manage multiple tasks, and meet deadlines in a
fast-paced environment.
Commitment
to maintaining confidentiality and upholding ethical standards in healthcare
operations.
Additional
Information:
This
position may require occasional travel to field locations or healthcare
facilities.
Fluency
in English (written and spoken) is required.
