Medical Claims Analyst at Old Mutual Kenya
| Location | NAIROBI, Kenya |
| Date Posted | July 2, 2025 |
| Category |
Audit
Communication Education / Teaching Health Care / Medical |
| Job Type |
Full-time
|
| Currency | KES |
Description
Old Mutual Kenya is based in Nairobi and is part of a larger group that offers solutions in long-term savings, asset management and investment. We offer solutions to individuals and corporates underpinned by our core values which are: Respect, Integrity, Accountability and Pushing beyond boundaries.
Medical Claims Analyst
Responsibilities
- Verify, audit and Vet medical claims for payment for both outpatient and inpatient claims as per the claim’s manual/Standard operating procedure.
- Adhere to customer service charter manual to ensure compliance to agreed turnaround times
- Prompt reporting of any identified risks during claims processing for mitigation.
- Monitor, prevent and control medical claims fraud/wastages during claims processing.
- Use of data analytics to review cost and quality of service at medical service providers.
- Hold regular business meetings with service providers to ensure compliance on systems such smart card system and agreed tariffs.
- Evaluate preliminary claim information and revert to broker or insured for more information where necessary to ensure that the correct information is documented for ease in processing of member reimbursement claim
- Respond to client enquiries within 24hrs of enquiry.
- Communicate and liaise with medical service providers on resolution of disputed claims.
- Any other duties assigned by management.
SKILLS AND COMPETENCIES
- Medical Claims Vetting, clinical experience.
KNOWLEDGE & EXPERIENCE
Qualifications:
- Bachelor’s degree in any medical related fields, Diploma in Nursing /Clinical Medicine or any medical related field.
Experience:
- 1-2 years
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Applying Instructions
Medical Claims Analyst
Lets Write Africa's Story Together!
Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.
Job Description
To process medical claims with a focus on cost control and management of member benefits through vetting and coding of inpatient and outpatient bills and capturing in the company medical business operating system(s).KEY TASKS AND RESPONSIBILITIES
- Verify, audit and Vet medical claims for payment for both outpatient and inpatient claims as per the claim’s manual/Standard operating procedure.
- Adhere to customer service charter manual to ensure compliance to agreed turnaround times
- Prompt reporting of any identified risks during claims processing for mitigation.
- Monitor, prevent and control medical claims fraud/wastages during claims processing.
- Use of data analytics to review cost and quality of service at medical service providers.
- Hold regular business meetings with service providers to ensure compliance on systems such smart card system and agreed tariffs.
- Evaluate preliminary claim information and revert to broker or insured for more information where necessary to ensure that the correct information is documented for ease in processing of member reimbursement claim
- Respond to client enquiries within 24hrs of enquiry.
- Communicate and liaise with medical service providers on resolution of disputed claims.
- Any other duties assigned by management.
SKILLS AND COMPETENCIES
- Medical Claims Vetting, clinical experience.
KNOWLEDGE & EXPERIENCE
Qualifications:
- Bachelor’s degree in any medical related fields, Diploma in Nursing /Clinical Medicine or any medical related field.
Experience:
- 1-2 years
The incumbent will be responsible for ensuring adherence to, implementation of, and adoption of Compliance, Anti-Money Laundering (AML), and Sanctions-related policies, procedures, and process requirements within Old Mutual and its subsidiaries. This includes execution of customer due diligence processes, ensuring compliance with Know-Your-Customer (KYC) standards, conducting ongoing and enhanced due diligence, and maintaining data quality. Additionally, the role involves identifying and monitoring potential AML, Sanctions, or Compliance breaches and unusual activities, and escalating these concerns to the Risk and Compliance Office for further action.
Skills
Competencies
Education
Closing Date
08 July 2025 , 23:59The Old Mutual Story!
About Us
Old Mutual is a premium African financial services organisation that offers a broad spectrum of financial solutions to retail and corporate customers across key market segments in 14 countries. The lines of business include Life and Savings, Property and Casualty, Asset Management and Banking and Lending.
We are rooted in our purpose of Championing Mutually Positive Futures Every Day and believe that a great customer experience is anchored in a great employee experience.