Latest Vacancies at CIC Insurance

Customer Care , Medical and Healthcare Jobs,  New Job Openings,

Call Centre Nursing Executive – Medical Contact Centre

PURPOSE:

To provide general customer service in respect to medical business customers.

PRIMARY RESPONSIBILITIES:

  • Receive and respond to Medical emergency lines and ensure 24 hour coverage.
  • Resolve customers’ communication through electronic and physical channels (Emails and walk in clients).
  • Issuance of both in and outpatient approvals for admissible requests for insured members.
  • Communication to stakeholders on management of cases and financial liability through reports.
  • Provide input for the customer service reports.
  • Handle customer service issues and queries.
  • Escalate Customer queries to the relevant job role if necessary.
  • Promote the organization’s customer service charter.

 Academic and Professional Requirements

Education  

  • Minimum of a Diploma in Nursing (KRCHN) 
  • Computer literate in MS Office and other office applications 
  • Customer Experience training will be an added advantage

Experience Required:

  • Relevant experience in busy health environment    3   
  • Experience in a medical call centre management unit    1

Claims Analyst/Vetting Officer – Medical

PURPOSE:

Responsible for vetting both in/ outpatient medical claims for payment.

PRIMARY RESPONSIBILITIES:

  • Vet and audit inpatient and outpatient medical bills/invoices in order to pay service providers promptly.
  • Process reimbursement claims within the stipulated TAT.
  • Batch outpatient invoices on the system and adjust amount payable as per the vetting findings;
  • Check and reject incomplete invoices and return with supporting documents to service providers;
  • Negotiate, adjust and update service providers on their cost and accounts status;
  • Reconcile statements of accounts for service providers; advising accounts and service providers on unpaid/underpaid bills;
  • Review claims reserves on a continuous basis in view of new developments;
  • Attend to stakeholder queries and complaints promptly and professionally
  • Recommend risk improvement measures to the underwriter to take appropriate action.
  • Fraud detention within claims function and escalation of any suspicious claims to the supervisor
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Academic and Professional Requirements

Education 

  • Minimum of a Diploma in Nursing (KRCHN)  
  • Computer literate in MS Office and other office applications  

Experience Required:

  • Relevant experience    3

Claims Receiving Officer – Medical

PURPOSE:

Responsible for receiving and processing claims for provider payment.

PRIMARY RESPONSIBILITIES:

  • Ensure that all claims received are well stamped and keyed in for future reference.
  • Dispatch received invoices, mails and claim books to respective sections
  • Dispatch claim forms and other relevant documents to providers
  • Confirm that smart claims have been billed correctly
  • Prepare valid claims for scanning.
  • Upload, attach and index relevant documents to Document Management System
  • Facilitate discarding of scanned claim documents as per the approved disposal procedure.
  • Registration of medical claims in the system
  • Follow up on registration and reconciliation of provider statements to ensure closure.
  • Follow through to ensure all claims with issues at registration level have been addressed or escalated to the supervisor for action
  • Respond to walk in customer enquiries
  • Attend to customer and service providers’ queries and complaints promptly and professionally

Academic and Professional Requirements

Education    

  • Bachelor’s Degree/Diploma    
  • Bachelor’s degree in a business related field or a Diploma in Health Records 
  • Computer literate in MS Office and other office applications 

Experience Required:

  • Relevant experience    1

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