Claims Vetting and Processing Officer

CIC Insurance Group Plc, founded in 1968, is a leading financial services provider in Kenya, specializing in banking, financial services, and insurance.

The Claims Vetting and Processing Officer is responsible for ensuring the company meets its commitments regarding assumed risks for clients. This involves a thorough analysis of all submitted claims to guarantee that only legitimate claims are processed for payment. A key aspect of the role is identifying and preventing fraudulent claims to effectively manage costs and keep loss ratios at a minimum. The officer is also tasked with precise assessment, cost containment, and timely processing of invoices to ensure efficient service delivery.

1. Vet and audit provider invoices to ensure validity and adherence to policy terms before payment.
2. Process allocated provider invoice payments within established timelines.
3. Manage costs by adhering to CIC's contracted rates and guidelines.
4. Advise clients and service providers on policy exclusions and non-payments promptly.
5. Monitor policy claims experience and provider trends, escalating findings to relevant teams for action.
6. Enhance system processes related to claims vetting and payment.
7. Respond to queries from providers and members regarding payments.
8. Negotiate discounts with service providers and maintain records of savings achieved.
9. Participate in account reconciliation and sign-off for allocated service providers to prevent service interruptions.
10. Prepare and share relevant claims reports as requested by the Assistant Manager.
11. Contribute to the department's planning and budgeting activities.
12. Support medical business events, both internal and those involving external stakeholders or the public.
13. Participate in various meetings and committees.
14. Perform any other duties assigned by the Assistant Manager Claims Vetting & Audit.

1. Bachelor of Science in Nursing.
2. KRN, KRCHN, or Clinical Medicine qualification is an added advantage.
3. Minimum of 1 year of relevant experience.