Principal Claims Management Officer - 15 Posts at The Social Health Authority (SHA)

The Social Health Authority (SHA) is a State Corporation established under the Social Health Insurance Act, 2023 and mandated to provide financial risk protection for Kenyan residents by facilitating equitable access to quality healthcare. SHA is responsible for administering the Social Health Insurance Fund, Primary Healthcare Fund, and Emergency, Chronic, ...

 

Principal Claims Management Officer - 15 Posts

  • Job TypeFull Time
  • QualificationBA/BSc/HND
  • Experience9 years
  • LocationNairobi
  • Job FieldInsurance  , Medical / Healthcare 

Qualifications, Skills and Experience Required:

Promotional-Claims Management-Medical Review: 

  • Cumulative period of services of nine (9) years of work experience, three (3) of which should have been at the grade of Senior Claims Management Officer or in a comparable position.
  • Bachelor’s Degree in Medicine and Surgery from a recognized institution.
  • A valid practicing license.
  • Certificate in Management course lasting not less than four (4) weeks from a recognized institution.
  • Membership to the relevant professional body and in good standing.
  • Proficiency in computer applications.
  • Shown merit and ability as reflected in work performance and results.

Responsibilities:

  • Undertaking medical reviews and interpretation of medical reports.
  • Undertaking reviewing, processing, and validating of medical claims from healthcare providers and facilities for accuracy and adherence to policies.
  • Undertaking the appraisal of medical claims based on the benefit package to ensure fair and timely disbursement of funds.
  • Implementing the issuance of pre-authorizations for access to healthcare services based on the benefit package to facilitate timely service provision.
  • Collecting and analyzing data for the e-claims and case management system to enhance efficiency and accountability.
  • Conducting quality assurance surveillance in respect of claims to ensure adherence to policies and detect irregularities.
  • Carrying out sensitization of claimants on the consequences of submitting false and fraudulent claims to reduce fraudulent activities.
  • Collecting and analyzing data for purposes of claim management to facilitate informed decision-making and continuous process improvement.
  • Collating and analyzing of data for preparation of quarterly reports on claims for submission for transparency and accountability.
  • Ensuring compliance with contractual obligations contracted and outsourced claims management services.

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Method of Application

Applicants must satisfy the requirements of Chapter Six of the Constitution of Kenya by submitting valid and current copies of the following:

  • Certificate of Good Conduct from the Directorate of Criminal Investigations.
  • Tax Compliance Certificate from the Kenya Revenue Authority.
  • Clearance Certificate from the Higher Education Loans Board (HELB).
  • Clearance Certificate from the Ethics and Anti-Corruption Commission (EACC).
  • Report from a Credit Reference Bureau (CRB).

SHA is an equal opportunity employer committed to diversity and gender equality. Canvassing will lead to automatic disqualification. Only shortlisted candidates will be contacted.

Interested and qualified? Go to The Social Health Authority (SHA) on recruitment.sha.go.ke to apply

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