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Madison Money Market Fund Daily Yield: 14.50% Effective Annual Yield: 15.51% Madison Fixed Income Fund Daily Yield: 14.95% Effective Annual Yield: 16.02%

Madison General Insurance Kenya Limited, a subsidiary of Madison Group and a leading provider of general insurance products throughout Kenya, is recruiting for the above position.

Key Responsibilities:

  • Oversee the claims process flows to ensure efficiency in processing of claims as per the company medical claims procedure manuals.
  • Supervise processing and settlement of medical claims as per the claims manual and customer service charter to ensure compliance and mitigate risk
  • Holding regular business meetings with service providers to ensure compliance with stipulated claims procedures and other contractual terms.
  • Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems and processes, as well as service providers.
  • Claims cost management through enforcement of agreed tariffs, negotiation of preferential rates and discounts, monitoring claims trends and conducting utilization review.
  • Reviewing of the outstanding claims regularly and monitoring team adherence to claims payments Turn Around Time (TAT).
  • Oversee the business document management process to ensure prompt scanning of claims documents and indexing in the relevant systems.
  • Supervise, train and mentor medical claims and operations staff to achieve a high level of motivation and productivity.
  • Prepare regular claims and operations reports to management, intermediaries and clients and advice underwriting team on relevant claims findings for medical risk review.
  • Working directly with finance team in management of service provider reconciliations, processing & release of payments.
  • Maintaining strong working relationships with service providers, Intermediaries, Clients, all departments and all business stakeholders
  • Work closely with ICT and Business analysts for any decision making on implementation of system requirements for claims cost management.
  • Complying with statutory, regulatory and internal control processes at the business units including internal & external audits recommendations.
  • Entrenching performance-based appraisal of departmental staff in line with their set KPI’s and departmental targets.
  • Any other roles assigned by management from time to time

Skills and Competencies Required

  • Strong leadership and management skills
  • Ability to work independently and build effective interpersonal relations
  • Bias towards innovation and development of new ideas in problem solving
  • Professionalism in dealing with both internal and external stakeholders
  • Excellent communication and negotiation skills.
  • Extensive networking with service providers and other medical insurers
  • Excellent analytical and monitoring skills
  • Ability to evaluate decisions made in benefit utilization management
  • Integrity and honesty

Knowledge & Experience

  • Demonstrated knowledge of managed care practices, medical claims management and business operations.
  • At least 3 years’ managerial experience in a medical insurance environment
  • Addressing operational concerns and issues, monitoring overall customer satisfaction.
  • Demonstrated experience engaging service providers at high level, and experience negotiating claims handling terms with providers
  • Developing and implementing operational procedures and policies

Academic and Professional Qualifications required

  • Degree in medicine/pharmacy/nursing or Business-Related field
  • ACII or DIP AIIK or CIM qualifications
  • Master’s Degree is an added advantage

Applications should be addressed to the Group Human Resources Manager, Madison Group Limited, Email: hr_recruitment@madison.co.ke so as to be received by Tuesday 9 th April, 2024.

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