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JOB ADVERTISEMENT

PACIS Insurance Company Limited was incorporated in Kenya in October 2004 and is an initiative of the Catholic Church, with a vision to be the icon of reliability and trustworthiness.  

In order to serve our growing client base, the company wishes to recruit an experienced, dynamic and innovative Medical Claims Analyst in our Medical Department.

MEDICAL CLAIMS ANALYST

JOB PURPOSE

To evaluate Medical claims submitted to the company and determine whether claims meet eligibility standard of the company and ensure that the medical customers receive proper care and assistance before, during admissions and on discharge.

To reduce the cost of Care by managing all treatment and procedures with the doctors and medical service providers.

MAIN DUTIES AND RESPONSIBILITIES

Claims Processing

  • Review capturing of all the medical /surgical bills for reasonable and necessary charges from service providers.
  • Examine coding for operative reports procedures and multiple complicated surgeries and ensure correctness In charging
  • Verifying and auditing   medical claims to ensure supporting documents   are attached and returning invoices without proper documentation to the provider for completeness.
  • Evaluate claims submitted from service providers for reimbursement and make decisions regarding reasonableness of the payments.
  • Recommend appropriate payment of disputed billing as necessary.
  • Monitors service providers in view of ensuring they maintain high standards of service delivery to Pacis Insurance Customers
  • Negotiate payment rates with medical service providers.
  • Carry out periodic review of reserves for claims at specified time and providing a report for the same to supervisor.
  • Process and settle authorized medical claims to service providers and insured in a fair and timely manner in accordance with the set standards and credit limits/periods.
  • Ensures that reconciliation of medical statement is done timely and all disputes addressed
  • Prepares monthly claims reports for the management      

Care Management

  • Pre-authorize scheduled and non-scheduled medical cases and timely issuance of letters of undertaking.
  • Review and maintain incurred claims amounts to a minimum by applying managed care tools, claims experience and analysis of benefits utilization patterns to ascertain the business viability.
  • Negotiation of the doctors’ bills and charges in view of reducing the cost of care before or during admissions
  • Visit patients admitted within Nairobi and follow up the ones admitted outside Nairobi
  • Provide second review of bills where providers question the appropriateness of payment authorized
  • Ensure customer queries and complaints are registered and follow through to finality
  • Resolve the customers queries and complains on time and advise them on details of the medical product
  • Recommends and Undertakes Health talks in liaison with the underwriters for all corporate medical schemes biannually.
  • Liaise with the intermediaries or corporate administrators and next of kin to the patients hospitalized as need arise.
  • Manages the Emergency calls in order to assist customers access medical care during office and off office ours
  • Facilitation of Admission , Discharges and Evacuation of Clients as per the company guidelines

Customer Service

  • Weekly running and sending out active members list to preferred panel of providers
  • Timely respond to clients queries, ,telephone call and letter regarding medical claims instituted to organization
  • Preparing and follow up on payment vouchers for service providers
  • Advising clients to utilize NHIF packages instead of spending on their insurance cover
  • Ensure adherence to contracts and service level agreements between providers and the company
  • Preparing and sending of the correct remittances to clients
  • Timely communication to clients about the status of their claims
  • Overseeing timely and accurate scanning of medical documents in Fortis
  • Any other duty assigned from time to time 

KNOWLEDGE, SKILLS AND EXPERIENCE.

Minimum Academic Qualifications

  • Business Degree qualification is an added advantage

Professional Qualifications

  • Diploma in Nursing/Clinical Officer

Skills and Attributes

  • Good Communication and interpersonal skills
  • Good analytical skills and keen on details
  • Excellent Negotiation skills
  • Effective decision maker

Experience

  • Three (3) years’ experience in medical insurance

Applications with a detailed CV, indicating the preferred location and telephone contacts with names and addresses of three referees should be emailed to hr@paciskenya.com not later than 15th February 2021.

ONLY SHORTLISTED CANDIDATES WILL BE CONTACTED

PACIS Insurance Company Limited was incorporated in Kenya in October 2004 and is an initiative of the Catholic Church, with a vision to be the icon of reliability and trustworthiness.  

In order to serve our growing client base, the company wishes to recruit an experienced, dynamic and innovate individual to fill the following position:

PURPOSE OF THE JOB:

The jobholder is primarily responsible for identifying sales leads, pitch services and maintain good relationship with customers to facilitate achievement of the set budgets set out in accordance with the Service Level Agreement aligned to the strategic objective of the Faith Based Division. Secondarily responsible for supervision of brand awareness, corporate communication, and customer satisfaction through developing and implementing a culture, policies and procedures that drive excellence in business acquisition.

MAIN DUTIES AND RESPONSIBILITIES:

Faith Based Division

Work to ensure the division executes the mandate as per the Faith Based Division strategy with a duty to:

  1. Contacting potential clients to establish relationships and sales
  2. Planning and overseeing new marketing initiatives.
  3. Researching trends and creating new opportunities to increase sales
  4. Increasing the value of current customers while attracting new ones.
  5. Finding and developing new markets and improving sales.
  6. Organizing and Attending Client conferences, meetings, and industry events.
  7. Developing quotes and proposals for clients.
  8. Developing goals for the development team and business growth and ensuring they are met.
  9. Training personnel and helping team members develop their skills
  10. Develop an annual calendar of marketing activities
  11. Establish a joint data base for all church affiliated business for existing clients
  12. Map and allocate resources to penetrate all regions with business potential countrywide
  1. Identify, target, and penetrate niche markets and create awareness of Pacis products within niche markets.

Other Marketing Functions:

  1. Supervise concept and content creation of all marketing and communication materials with the design team, ensuring high quality execution and achieving emerging markets account growth
  2. Enhance Pacis product training to the marketing team by organizing regular trainings
  3. Collect market intelligence from the competition and compile such information to management
  4. Organize company marketing events
  5. Create and build the Pacis brand within the niche/affiliated institutions to enhance market awareness
  6. Monitoring brand attributes implementation and ensuring their consistency throughout the organization
  7. Organize and coordinate Pacis’ Annual CSR and sponsorship events and create opportunity for brand and media publicity
  8. Organize and coordinate advertising/product campaigns, press releases and public relations activities with targeted communications including brand awareness and visibility.

KNOWLEDGE, SKILLS AND EXPERIENCE:

Academic Qualifications

  • Bachelor’s degree in Commerce/Business Administration
  • Training in intermediary management is an added advantage

Professional Qualifications

  • Diploma in Marketing
  • Diploma in Insurance

Experience

  • Five (5) years’ experience in an insurance or other financial services organization.

Skills and Attributes

  • Good networking and interpersonal skills
  • Excellent negotiation & persuasion skills
  • Excellent oral and written communication skills
  • Result oriented
  • Tenacious
  • Able to work with minimum supervision
  • Knowledgeable about the market

Applications with a detailed CV, indicating the preferred location and telephone contacts with names and addresses of three referees should be emailed to hr@paciskenya.com not later than 05th February 2021.

ONLY SHORTLISTED CANDIDATES WILL BE CONTACTED

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