Claims Assurance Officer - Embakasi

Main Responsibilities

Claims Documentation & Assurance

Verify completeness and accuracy of insurance documentation prior to service delivery.

Ensure insurance and patient details are correctly entered in the system.

Validate pre-authorizations, NHIF codes, QR codes, diagnosis, and required claim attachments.

Front Office Oversight

Supervise client service teams to ensure compliance with billing and documentation SOPs.

Conduct ongoing training on insurance procedures, documentation standards, and system updates.

Rejection Prevention

Analyze claim rejection trends and address root causes.

Identify high-risk claims and escalate incomplete or inconsistent documentation for immediate resolution.

Interdepartmental Coordination

Act as liaison between clinical, reception, and finance departments to ensure seamless documentation flow.

Coordinate with insurance providers for clarifications or additional documentation needs.

Reporting & Audit

Prepare daily and weekly reports on documentation compliance, rejection metrics, and flagged claims.

Support internal audits and help implement corrective action plans to improve claims quality.

Financial & Operational Oversight

Monitor invoicing reports, banking transactions, and Oracle purchases.

Assist in cost optimization initiatives and ensure inventory accuracy.

Customer Experience

Resolve patient concerns regarding billing and documentation professionally.

Support a patient-first approach by ensuring clarity and transparency in the billing process.

Perform any additional duties as assigned by management to support the revenue assurance function.

Industries:Health, Wellness & Fitness

Function: Others