Full Time
Nairobi, Kenya
Posted 7 months ago
$40,000 - $60,000 per annum (estimate) USD / Year
Salary: $40,000 - $60,000 per annum (estimate)

Kenbright

CLAIMS ASSESSORS

Qualifications

Candidates for the position of Claims Assessor should possess the following qualifications:

Degree or Diploma in medicine, Insurance, finance or a related field.
Past experience in the insurance industry is an added advantage.
2 years experience in a similar or related role.
Relevant certificates and licenses are an advantage.

Duties and Responsibilities

As a Claims Assessor, your responsibilities will include:

Confirming eligibility cover: Ensuring that insurance coverage criteria are met.
Reviewing and processing medical insurance claims for accuracy and compliance: Thoroughly assessing claims to ensure they meet company standards and regulatory requirements.
Identifying fraud in submitted claims: Vigilantly detecting any fraudulent activities in the claims process.
Collaborating with healthcare providers to resolve claim discrepancies: Working closely with medical professionals to resolve any inconsistencies or issues with claims.
Analyzing medical data and history to determine coverage eligibility: Using medical records and information to make informed decisions about insurance coverage.

Only shortlisted candidates will be contacted.

Submit your CV and Cover letter indicating your salary expectations through hr@kenbright.africa.

Deadline: 29th March 2024

Visit our website for more information: www.kenbright.co.ke

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Expert Tips To Be A Successful Applicant for Claims Assessor

Highlight Relevant Experience: Showcase any previous experience in the insurance industry or roles involving claims assessment to demonstrate your suitability for the position.
Emphasize Attention to Detail: In your application materials, emphasize your strong attention to detail, a crucial skill for accurately assessing insurance claims.
Demonstrate Analytical Skills: Provide examples of how you’ve analyzed complex medical data or situations in your previous roles to showcase your analytical abilities.
Showcase Communication Skills: Communication is key in collaborating with healthcare providers and resolving claim discrepancies. Highlight instances where you effectively communicated with stakeholders.
Stay Updated: Keep abreast of developments in the insurance industry, particularly regarding fraud detection and compliance standards, to demonstrate your commitment to staying informed.
Tailor Your Application: Customize your CV and cover letter to align with the specific requirements and responsibilities outlined in the job description for the Claims Assessor role.
Quantify Achievements: If possible, quantify your achievements in previous roles related to claims assessment, such as processing a certain number of claims per day or reducing fraudulent claims.
Research the Company: Familiarize yourself with Kenbright Africa’s mission, values, and services to demonstrate your genuine interest in joining the organization.
Seek Feedback: If you have contacts in the insurance industry, consider seeking feedback on your application materials to ensure they effectively showcase your qualifications and experience.
Follow Up: After submitting your application, consider following up with the hiring team to express your continued interest in the position and inquire about the status of your application.

SAMPLE COVER LETTER FOR A CLAIMS ASSESSOR

[Your Name]

[Your Address]

[City, State, Zip]

[Your Email Address]

[Your Phone Number]

[Date]

[Hiring Manager’s Name]

[Company Name]

[Company Address]

[City, State, Zip]

Dear [Hiring Manager’s Name],

I am writing to express my interest in the Claims Assessor position at [Company Name], as advertised. With a [Your Degree/Diploma] in [Your Field] and over [Number of Years] years of experience in the insurance industry, I am confident in my ability to contribute effectively to your team.

In my previous role at [Previous Company Name], I successfully [Highlight Key Achievement or Responsibility Relevant to Claims Assessing]. This experience has equipped me with the skills and knowledge necessary to excel in a Claims Assessor role, including [List Skills or Qualities Relevant to Job Description].

I am particularly drawn to this position at [Company Name] because of [Highlight Company’s Unique Selling Points or Attractive Features]. I am eager to bring my expertise in claims assessing to your esteemed organization and contribute to its ongoing success.

Please find attached my CV for your consideration. I am available for an interview at your earliest convenience and can be reached at [Your Phone Number] or via email at [Your Email Address].

Thank you for considering my application. I look forward to the opportunity to discuss how my skills and experiences align with the needs of [Company Name].

Warm regards,

[Your Name]

Frequently Asked Questions

1. What qualifications are required for the Claims Assessor position?

To be eligible for the Claims Assessor role, candidates should have a Degree or Diploma in medicine or a related field. Past experience in the insurance industry is advantageous, along with at least 2 years of experience in a similar or related role. Possession of relevant certificates and licenses is also beneficial.

2. How should I apply for the Claims Assessor position?

To apply for the Claims Assessor position, please submit your CV and Cover letter indicating your salary expectations through hr@kenbright.africa. The deadline for applications is 29th March 2024.

3. What are the main responsibilities of a Claims Assessor?

The main responsibilities of a Claims Assessor include confirming eligibility cover, reviewing and processing medical insurance claims for accuracy and compliance, identifying fraud in submitted claims, collaborating with healthcare providers to resolve claim discrepancies, and analyzing medical data and history to determine coverage eligibility.

4. Is proficiency in English required for the Claims Assessor position?

Yes, fluency in English is required as all communications and documentation within the company are conducted in English.

5. Are there opportunities for career advancement within the company?

Yes, we value the professional growth of our employees and provide opportunities for career advancement and development within the organization.

6. What is the application deadline for the Claims Assessor position?

The application deadline for the Claims Assessor position is 29th March 2024.

7. Is remote work available for the Claims Assessor role?

At present, this position requires on-site work at our location. Remote work options may be considered in the future depending on organizational needs and policies.

8. What should I include in my Cover letter when applying for the Claims Assessor position?

Your Cover letter should include your interest in the position, a brief overview of your qualifications and experiences relevant to the role, and your salary expectations.

9. How will I know if my application has been successful?

Only shortlisted candidates will be contacted for further steps in the recruitment process.

10. Are there any specific skills or qualities that are highly valued for the Claims Assessor role?

Attention to detail, analytical skills, communication skills, and the ability to work efficiently under pressure are highly valued qualities for the Claims Assessor role.

Possible Claims Assessor Interview Questions With Answers

1. Can you walk us through your experience in the insurance industry?

Answer: Certainly. I have been working in the insurance industry for [Number of Years], primarily focusing on [Highlight Relevant Experience or Achievements]. My experience has provided me with a comprehensive understanding of insurance processes and regulations.

2. How do you ensure accuracy and compliance when reviewing insurance claims?

Answer: I meticulously review each claim, cross-referencing it with relevant documentation and guidelines to ensure accuracy and compliance. Additionally, I stay updated on industry regulations and best practices to maintain compliance standards.

3. How do you handle situations where fraudulent activities are suspected in submitted claims?

Answer: When I encounter suspected fraudulent activities, I conduct a thorough investigation, gathering evidence and documentation to support my findings. I then escalate the issue to the appropriate authorities or management for further action.

4. Can you provide an example of a challenging claim discrepancy you encountered and how you resolved it?

Answer: Certainly. In a previous role, I encountered a claim discrepancy involving conflicting medical records. I collaborated closely with the healthcare provider to clarify the discrepancy and obtain additional information. Through effective communication and problem-solving, we were able to resolve the issue satisfactorily.

5. How do you prioritize and manage multiple claims simultaneously?

Answer: I prioritize claims based on their urgency and complexity, ensuring that critical cases receive immediate attention. I also utilize organizational tools and strategies to efficiently manage multiple claims concurrently, maintaining accuracy and timeliness throughout the process.

6. How do you stay updated on changes in insurance regulations and industry trends?

Answer: I regularly participate in professional development opportunities, such as workshops, seminars, and online courses, to stay updated on changes in insurance regulations and industry trends. Additionally, I actively engage with industry publications and networks to remain informed and adaptable in my role.

7. Can you describe a situation where you had to collaborate with healthcare providers to resolve a claim discrepancy?

Answer: Certainly. In a recent case, I encountered a claim discrepancy related to medical billing codes. I collaborated closely with the healthcare provider to review the documentation and identify the source of the discrepancy. Through effective communication and collaboration, we were able to rectify the issue and process the claim accurately.

8. How do you handle situations where a claim’s eligibility cover is uncertain?

Answer: When faced with uncertainty regarding a claim’s eligibility cover, I conduct a thorough review of the policy terms and relevant documentation. If necessary, I consult with colleagues or superiors to clarify any ambiguities and ensure accurate determination of eligibility. Transparency and communication are key in such situations to provide clarity to all stakeholders involved.

9. Can you discuss a time when you had to make a difficult decision regarding a claim’s coverage eligibility?

Answer: Certainly. In a previous role, I encountered a complex case where the claim’s coverage eligibility was unclear due to overlapping medical conditions. After carefully analyzing the medical records and consulting with medical professionals, I made a decision based on the policy terms and the best interests of the insured. While difficult, I prioritized fairness and adherence to company guidelines in reaching a resolution.

10. How do you handle the pressure of meeting tight deadlines in claims processing?

Answer: I thrive under pressure and have developed effective time management strategies to meet tight deadlines in claims processing. By prioritizing tasks, staying organized, and maintaining clear communication with stakeholders, I ensure that deadlines are met without compromising quality or accuracy. Additionally, I remain adaptable and focused, utilizing resources efficiently to achieve timely results.

Rough Salary Range Estimate:

$40,000 – $60,000 per annum, depending on qualifications and experience.

Best wishes in your application process!

At Kenbright, we are committed to attracting and retaining the best employees from all races and backgrounds in our continued effort to become a better development partner. We are an equal opportunity employer and do not charge any application/recruitment fees, whether refundable or not.

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To apply for this job email your details to hr@kenbright.africa