Junior Claims Assessor

CarePay is an international, fast-growing fintech company with offices in Kenya, Nigeria, Tanzania and the Netherlands. Our company’s vision is to make mobile health insurance accessible to everyone by using state-of-the-art technology against no marginal costs. We strongly believe in leveraging the mobile technology revolution to transform the health insurance sector. CarePay has developed a smart payment distribution platform on the foundations of the mobile money ecosystem, which permanently connects patients, premium payers, insurers and healthcare providers on our platform. The platform provides mobile health wallets which allow all stakeholders to send, receive and pay dedicated healthcare funds to each other instantly and thereby reducing costs, creating huge data value and enhancing transparency and accountability. CarePay’s platform has connected over 4.5 million participants and 1,200 healthcare facilities and is now expanding its business internationally, starting with Nigeria and Tanzania.

Since its start, CarePay has received wide-spread international coverage and traction. In 2017, CarePay won the FT/IFC Transformational Business Award and in 2018 CarePay was recognized as a Technology Pioneer 2018 by the World Economic Forum, following the footsteps of long line of successful companies, such as Google (2001), Twitter (2009) and Airbnb (2013). In 2019, CarePay won the Swiss Re Entrepreneurs for Resilience Award.

MAIN PURPOSE OF THE JOB:

The Junior Claims Assessor will have the responsibility of ensuring that medical claims are vetted and that they meet the set objectives for a given project. The position will also involve giving detailed reporting on all the general findings from the claims vetted with the aim of improving project outcomes as well as enhancing system functionality.

KEY DUTIES AND RESPONSIBILITIES:

• Verify and analyze all data on claims and ensure these meet the project objectives as well as payer expectations for the various projects.
• To send back simple yet detailed feedback to the provider team where claims do not meet the project expectations.
• To ensure any general trends or inconsistencies noted are reported to the operations and provider teams.
• Timely reassessing of claims re-submitted by the providers, ensuring the queries raised are understood, and following up with the provider team to ensure they are resolved.
• Provide support to the customer call center to address medical queries that have been escalated to CarePay.
• Document and be able to extract, present, or discuss provider practices or disease trends.
• Deliver feedback and training aimed at addressing the trends picked from the claims assessment exercise.
• Mapping generic rules to medical services, procedures, drugs and lab tests.
• Participate in testing and documentation of selected CarePay systems.
• Support with Case Management.
• Perform all other duties as assigned by the supervisor.

EDUCATIONAL QUALIFICATIONS, KNOWLEDGE & EXPERIENCE:

• Degree / Diploma in Nursing or other suitable medical background or other closely related field.
• Good understanding of private and public healthcare delivery.
• Have a strong understanding of medical treatment protocols and cost-effective prescribing habits in relation to market segmentation.
• At least 2 years’ experience in a busy hospital set-up.

KEY SKILLS AND COMPETENCIES:

• Good analytical and problem-solving skills.
• Excellent oral and written communication skills.
• Strong interpersonal skills with ability to work with cross-cultural and diverse people and teams..
• Collaboration and team working skills.
• Customer service skills.
• Data Entry skills with ability to produce accurate work.
• Reporting and good attention to details.
• Ability to prioritize and work to meet deadlines.
• Flexible and ability to adapt or change to new situations and handle high levels of uncertainty.
• Ability to maintain confidentiality.
• Personal qualities of integrity, credibility, professionalism, and a commitment to CarePay’s mission.