Job Title: Assistant Claims Officer (1 Year Fixed-Term Contract) – (2400000M)

Job Title: Assistant Claims Officer (1 Year Fixed-Term Contract) – (2400000M)

Job Purpose and Key Responsibilities

Job Purpose: As an Assistant Claims Officer, your primary objective is to efficiently process medical claims, ensuring accuracy and compliance with established protocols. This role involves verifying and updating claim information, reviewing reimbursement policies, and facilitating payment negotiations.

Key Responsibilities:

• Establish appropriate parameters for each admission, including claim reserves and initial authorized costs.
• Liaise with clients and service providers to ensure adherence to policy guidelines.
• Review medical reports and claims for compliance with established guidelines.
• Collaborate with underwriters to determine scope of cover for various schemes.
• Advocate against polypharmacy through rigorous prescription review and promotion of generic substitution.
• Generate periodic reports for management regarding medical claims.
• Ensure timely processing of claims within stipulated timelines.
• Exercise delegated authority as per the approved matrix.

Key Performance Measures: Performance will be evaluated based on criteria outlined in your Personal Score Card.

Knowledge, Experience, and Qualifications Required

• Diploma/Degree in Nursing, Clinical Medicine, or Pharmacy.
• Moderate understanding of insurance concepts.
• 2-4 years of experience in claims management within a dynamic insurance environment.

Technical/Functional Competencies

• Familiarity with insurance regulatory requirements.
• Proficiency in insurance product knowledge.
• Strong sales and marketing management skills.

Primary Location: Kenya-Nairobi-Nairobi
Organization: Business
Job Type: Contractual
Shift: Day Job
Contract Type: Full-time
Posting Date: 22-02-2024
Unposting Date: 29-02-2024
Number of Openings: 1

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Expert Tips To Be A Successful Applicant for Assistant Claims Officer:

1. Demonstrate Attention to Detail: Showcase your ability to meticulously review and process claims, ensuring accuracy and compliance.
2. Highlight Communication Skills: Emphasize your proficiency in liaising with clients and service providers to facilitate smooth claims processing.
3. Showcase Industry Knowledge: Illustrate your understanding of insurance concepts and regulations to stand out as a knowledgeable candidate.
4. Provide Examples of Problem-Solving: Describe instances where you effectively resolved claim-related challenges, showcasing your problem-solving abilities.
5. Illustrate Team Collaboration: Share experiences of collaborating with underwriters and other team members to achieve common goals.
6. Emphasize Time Management: Highlight your track record of meeting tight deadlines and ensuring timely claims processing.
7. Showcase Analytical Skills: Demonstrate your ability to analyze medical reports and claims to ensure compliance with guidelines.
8. Illustrate Adaptability: Provide examples of how you adapt to changing situations within a fast-paced insurance environment.
9. Highlight Customer Service Skills: Showcase your ability to provide excellent customer service while handling claim inquiries and negotiations.
10. Express Enthusiasm for Continuous Learning: Communicate your willingness to stay updated with industry trends and regulations, showcasing a commitment to professional growth.

SAMPLE COVER LETTER FOR AN ASSISTANT CLAIMS OFFICER POSITION

[Your Name]
[Your Address]
[City, State, Zip Code]
[Your Email Address]
[Your Phone Number]
[Date]

[Hiring Manager’s Name]
[Company Name]
[Company Address]
[City, State, Zip Code]

Dear [Hiring Manager’s Name],

I am writing to express my interest in the Assistant Claims Officer position at [Company Name], as advertised. With a [Your Degree] in [Your Field] and [Number of Years] years of experience in claims management within the insurance industry, I am excited about the opportunity to contribute to your team and support your mission of efficient claims processing.

During my tenure at [Previous Company], I successfully managed a diverse portfolio of claims, ensuring accuracy and compliance with regulatory standards. My strong communication skills enabled me to effectively liaise with clients and service providers, fostering positive relationships and facilitating smooth claims processing.

I am particularly drawn to [Company Name] due to its reputation for excellence in the industry and its commitment to innovation. I am eager to bring my expertise in claims management to your esteemed organization and contribute to the achievement of your goals.

Thank you for considering my application. I am looking forward to the possibility of discussing how my skills and experiences align with the needs of your team further. Please find my resume attached for your review.

Sincerely,

[Your Name]

Frequently Asked Questions:

1. What qualifications are required for the Assistant Claims Officer role?

• A Diploma/Degree in Nursing, Clinical Medicine, or Pharmacy is required, along with 2-4 years of experience in claims management within the insurance industry.

2. What are the key responsibilities of an Assistant Claims Officer?

• Responsibilities include verifying and updating claim information, reviewing reimbursement policies, liaising with clients and service providers, preparing reports, and ensuring timely claims processing.

3. How can I stand out as an applicant for this role?

• You can stand out by demonstrating attention to detail, strong communication skills, industry knowledge, problem-solving abilities, and a commitment to continuous learning.

4. Is this position based in Nairobi, Kenya?

• Yes, the primary location for this role is in Nairobi, Kenya.

5. What is the contract type for this position?

• This is a full-time contractual position for a duration of 1 year.

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

• Yes, the company offers opportunities for career growth and development based on performance and merit.

7. How soon is the posting for this position closing?

• The unposting date for this position is 29-02-2024.

8. Is there a probationary period for this role?

• The job description does not mention a probationary period. However, this can be clarified during the interview process.

9. Are there opportunities for training and professional development?

• Yes, the company encourages continuous learning and provides opportunities for training and professional development.

10. Is [Company Name] an equal opportunity employer?

• Yes, [Company Name] is committed to attracting and retaining a diverse workforce and does not discriminate based on race, gender, religion, or any other characteristic.

Possible Assistant Claims Officer Interview Questions With Answers:

1. Can you walk me through your experience in claims management?

• Answer: Certainly. In my previous role at [Previous Company], I was responsible for managing a portfolio of claims, including verifying information, reviewing policies, and ensuring timely processing.

2. How do you prioritize tasks in a fast-paced environment?

• Answer: I prioritize tasks based on urgency and impact, ensuring that critical tasks are addressed first while maintaining attention to detail.

3. How do you handle difficult clients or service providers during the claims process?

• Answer: I approach difficult situations with empathy and professionalism, seeking to understand concerns and find mutually beneficial solutions.

4. How do you stay updated with changes in insurance regulations?

• Answer: I actively engage in professional development opportunities, such as attending seminars and workshops, and regularly review industry publications to stay informed about regulatory changes.

5. Can you provide an example of a time when you had to resolve a complex claim issue?

• Answer: Certainly. In a recent case, I encountered a discrepancy in claim documentation, which required thorough investigation and collaboration with various stakeholders to resolve satisfactorily.

6. How do you ensure accuracy in claim processing?

• Answer: I employ a systematic approach to claim verification, double-checking information and cross-referencing against established guidelines to ensure accuracy.

7. How do you handle confidential information related to claims?

• Answer: I understand the importance of confidentiality in claims management and adhere to strict protocols to safeguard sensitive information.

8. Can you describe your experience with generating reports for management?

• Answer: I have experience in preparing comprehensive reports that provide insights into claims trends, performance metrics, and areas for improvement, facilitating informed decision-making by management.

9. How do you handle situations where claims require further investigation?

• Answer: I approach such situations methodically, gathering additional information, consulting with relevant parties, and documenting findings to ensure thorough resolution.

10. What motivates you to pursue a career in claims management?

• Answer: I am motivated by the opportunity to make a meaningful impact by ensuring fair and timely reimbursement for policyholders, thereby contributing to the overall success of the insurance company.

We wish you the best in your application process and remind you that Britamis committed to attracting and retaining the best talent from diverse backgrounds. We do not charge any application/recruitment fee, whether refundable or not, as we strive to maintain fairness and transparency in our hiring process.

THE KENYAN JOBFINDER