Job Ref. No: JHIL197
Role Purpose
The Claims
Registrar will be responsible for the efficient
assessment and registration of claims in strict adherence to established
standards, policies, and procedures. The role requires a keen eye for detail,
ensuring accuracy and compliance throughout the claims process. Additionally,
the role holder will be expected to maintain a high level of productivity by
consistently meeting daily targets, demonstrating both efficiency and
reliability in delivering quality service.
Main Responsibilities
Operational
- Verification of Member and Provider Details –
Thoroughly review and confirm the accuracy of member, scheme, and provider
information before data entry to ensure seamless claims processing.
- Precise Data Capture – Accurately input claim
details into the system from claim documents, minimizing errors and
maintaining data integrity.
- Efficient Claims Indexing – Systematically
categorize and index claims using the Invoice ID for easy retrieval and
streamlined processing.
- Quality Control for Scanning – Identify and flag
claims requiring rescanning due to poor legibility, ensuring that all
records are clear and complete for assessment.
- Collaborative Issue Resolution – Engage
experienced staff for guidance and clarification on complex cases,
ensuring claims are processed correctly and efficiently.
- Claims Validation and Vetting – Carefully assess
the validity of services provided by verifying treatment details, benefit
coverage, provider panel adherence, and treatment costs to uphold
compliance and prevent discrepancies.
- Communication and Notation – Utilize the Notes
function to alert approvers of any irregularities or notable observations
during the registration process, enhancing transparency and
decision-making.
Corporate
Governance
- Ensure strict adherence to industry regulations,
insurance claims protocols, and corporate policies to safeguard the
organization’s integrity and mitigate legal risks.
- Uphold the laws and regulations of Kenya,
including insurance claims procedures, anti-fraud measures, and internal
risk controls, while ensuring company policies are implemented
consistently across all claims processes.
- Ensure all claim-related documentation is
accurate, secure, and audit-ready, minimizing exposure to fraud and
regulatory penalties.
Culture
- Promote ethical decision-making in claims
adjudication, ensuring claimants are treated with respect and fairness
while upholding the company’s reputation as a responsible corporate
citizen.
- Champion initiatives that enhance employee
engagement, resilience, and a shared commitment to excellence.
- Create personalized development plans that align
with your career aspirations and the organization’s objectives
Key
Competencies
- Strong background in medical claims assessment,
including knowledge of medical terminology, coding (ICD-10, CPT, HCPCS),
and treatment procedures.
- Experience working with insurance regulatory
compliance, fraud detection, and risk mitigation in claims processing.
- Familiarity with policy interpretation and
customer service in handling claims disputes and resolutions.
- Proficiency in claims management systems and
data analysis tools used in health insurance.
- Hands-on experience coordinating with healthcare
providers, underwriters, and legal teams to validate and process claims
efficiently.
- Academic and Professional Qualifications
- Bachelor’s degree /Diploma in Nursing, Clinical
Medicine, Healthcare Management, or a related field.
- Relevant certifications in customer service or
customer experience are advantageous.
Relevant
Experience
At least
1 year of experience in health insurance claims processing, adjudication, or
claims management.
How to Apply
If you
are qualified and seeking an exciting new challenge, please apply via Recruitment@jubileekenya.com quoting
the Job Reference Number and Position by 3rd November 2025. Only shortlisted
candidates will be contacted.
