Old Mutual
Medical Claims Vetter Job Overview
Old Mutual, a leading African financial services organization, is seeking a skilled Medical Claims Vetter to join their innovative team in Nairobi. This critical role plays a crucial part in managing medical claims, ensuring cost control, and maintaining the highest standards of member benefits processing.
Job Highlights
- – Location: Nairobi
- – Job Requisition ID: JR-60836
- – Posted: 3 Days Ago
- – Closing Date: 12 December 2024, 23:59
Role Purpose
The Medical Claims Vetter will be instrumental in processing medical claims with a strategic focus on cost management, member benefit optimization, and ensuring operational excellence through meticulous claims vetting and coding.
Key Responsibilities
Claims Processing and Verification
- – Process medical claims for both inpatient and outpatient services
- – Verify, audit, and vet medical claims according to the company’s claims manual and Standard Operating Procedures
- – Evaluate preliminary claim information and request additional documentation when necessary
- – Ensure accurate documentation for member reimbursement claims
Cost Control and Risk Management
- – Monitor, prevent, and control medical claims fraud and wastages
- – Utilize data analytics to review service costs and quality from medical service providers
- – Conduct proactive risk identification and reporting during claims processing
- – Hold regular business meetings with service providers to ensure system compliance and tariff agreements
Customer Service and Communication
- – Respond to client inquiries within 24 hours
- – Communicate and liaise with medical service providers to resolve disputed claims
- – Adhere to the customer service charter manual
- – Ensure compliance with agreed turnaround times
System and Operational Management
- – Capture claims in the company’s medical business operating system
- – Use advanced data analytics tools for comprehensive claims review
- – Maintain accurate and up-to-date records
- – Perform additional duties as assigned by management
Required Qualifications and Skills
Educational Requirements
- – Bachelor’s degree in a medical-related field
- – Diploma in Nursing or Clinical Medicine
- – Strong understanding of medical claims processing
Essential Skills
- – Advanced medical claims vetting expertise
- – Clinical experience
- – Proficiency in data analytics
- – Excellent analytical and problem-solving abilities
- – Strong attention to detail
- – Exceptional communication skills
- – Ability to work in a fast-paced environment
Workday and Career Opportunities
Old Mutual offers comprehensive career opportunities through their Workday platform, providing transparent and accessible job listings. The careers.oldmutual.com portal offers multiple opportunities, including jobs for matriculants and entry-level positions across various departments.
Old Mutual My Workday Benefits
- – Seamless career management tools
- – Transparent job application process
- – Professional development opportunities
- – Comprehensive benefits package
Why Choose Old Mutual?
- – Be part of a purpose-driven organization
- – Contribute to Africa’s financial and healthcare ecosystem
- – Work with a diverse and inclusive team
- – Potential for professional growth
- – Competitive employment in the financial services sector
Application Process
Interested candidates passionate about medical claims management and making a difference in healthcare financing are encouraged to apply. Demonstrate your expertise, commitment to excellence, and ability to drive operational efficiency.
Old Mutual is an equal opportunity employer committed to diversity and inclusion in the workplace.
Additional Information
- – Candidates must be legally authorized to work in Kenya
- – Previous experience in medical claims processing is advantageous
- – Proficiency in local languages is a plus
