Role Title:

Senior Claims Analyst – 1 Post

Business Unit(s):

Rwanda

Business /Function:

Senior Claims Analyst

Location:

Rwanda-Kigali

Reports To:

Health Manager

MDP Level:

Manager of others

Role Size

M

JOB SUMMARY

To ensure prompt settlement of medical claims within the Company’s policy terms and

conditions.

PRINCIPAL ACCOUNTABILITIES.

Verify and audit outpatient and inpatient claims as per the claims manual to ensure
compliance.
Negotiate professional fees and hospital charges including discounts to control
expenditure.
Oversee processing & settlement of all claims and authorize requisitions.
Develop and maintain service provider panels by holding regular business meetings with key service providers
Supervise train and mentor staff.
Monitor, prevent and control medical claims fraud by making necessary visits to service providers as situations require
Prepare regular claims reports to clients, management and advice underwriter health on relevant claims findings for medical risk review.
To perform any other task that may be assigned by his superior.
Qualifications and experience

University Degree in Medicine or Health related.
Basic Insurance qualification.
Skills and competencies

Good communication and negotiation skills.
Good public relations and interpersonal relationship skills.
Extensive networking with SP and other medical insurers
Good analytical and monitoring skills
User IT skills in database management and office systems.
Good decision-making skills.
Integrity and honesty.