MEDICAL CLAIMS ANALYST

CIC Insurance Group is a leading insurance and financial services organisation with more than five decades of experience helping individuals, families, and organizations achieve financial security.

We have grown into a dynamic Group offering life, general, micro insurance, asset management, and investment solutions, with operations in Kenya, Uganda, South Sudan, and Malawi, and are listed on the Nairobi Securities Exchange.

Our tagline, “We Keep Our Word,” reflects our unwavering commitment to integrity, transparency, and delivering on our promises to our clients, partners, and communities.

CIC Group is passionate about innovation, digital transformation, and inclusive insurance solutions that meet the evolving needs of cooperatives, SMEs, corporates, and individuals. By joining us, you will be part of a team that is shaping the future of financial protection across Africa.

CIC Africa Insurance (SS) Ltd, a subsidiary of CIC Insurance Group is looking to recruit highly skilled individuals to fill the position of Medical Claims Analyst to be based in the Head Office in Kenya. Reporting to the Medical Supervisor – Claims & Care Service Management, the role holder will be responsible vetting both in/ outpatient medical claims for payment.

• Vet in/outpatient medical bills/invoices and refer any suspicious claims to the supervisor; 
• 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 costs 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 customer queries and complaints promptly and professionally and 
• Recommend risk improvement measures to the underwriter to take appropriate action. 

• Bachelor’s degree in a related field or a Diploma in Nursing / Diploma in Clinical Medicine. 
• Minimum of 3 years of relevant experience. 
• Registered Nursing, Diploma – Required  
• Excellent communication and presentation skills 
• Problem solving skills 
• Excellent interpersonal skills  
• Good negotiation skills 
• Good analytical skills 
• Computer literate in MS Office and other office applications 
• Understanding of the working environment /competitors 
• Technical competence in insurance  
• Basic knowledge of regulations by the regulators