Medical Claims Officer

Absa General Insurance Co is seeking a detail-oriented Medical Claims Officer to join their team at the Gitanga Road location. This full-time position offers an excellent opportunity for insurance professionals with medical background to support the Medical Claims Manager in delivering exceptional claim services to customers.

About Absa bank

With over 100 years of rich history, Absa is strongly positioned as a local bank with regional and international expertise. Joining Absa offers the opportunity to be part of an exciting growth journey and help shape the future of this proudly African group. Absa’s Career Development Portal provides leading-edge guidance, tools, and support to unlock your potential throughout your career journey.

Medical Claims Officer Job Purpose

As a Medical Claims Officer, you will provide operational support in the medical claims processes and settle insurance claims in a fast, fair, and courteous manner to ensure customer satisfaction, company profitability, and maintain a good corporate image.

Key Responsibilities

Claims Vetting and Approval

• – Receive and register incoming claims
• – Perform claims adjudication
• – Analyze patients’ claims for completeness and validity before processing them for payment
• – Examine and confirm member benefits, entitlements, and exclusions
• – Prepare member statements regarding policy benefit utilization status when requested
• – Prepare payment remittances and credit notes where applicable
• – Liaise with providers on claims queries
• – Prepare management reports

Customer Service and Provider Relations

• – Handle customer queries (walk-in, phone & email) regarding claims and payments
• – Assist in reconciliation processes and attend reconciliation meetings with providers

Requirements

Education

• – Bachelor’s degree in Actuarial Science OR
• – Diploma in Pharmacy, Clinical Medicine, Nursing, Laboratory, or any other medical-related course
• – Further Education and Training Certificate (FETC): Business, Commerce, and Management Studies is required
• – COP (Certificate of Proficiency in Insurance) & ACII will be an added advantage

Experience and Skills

• – At least one year of experience in a busy insurance-related field
• – Strong analytical skills
• – Customer service orientation
• – Attention to detail
• – Excellent communication skills

Additional Information

• – Position ID: R-15974554
• – Location: Gitanga Road (Absa General Insurance Co)
• – Posted: 2 days ago

Absa empowers Africa’s tomorrow through its commitment to possibility and growth. Join their team and be part of shaping the future of financial services in Africa.