Jubilee Insurance Hiring Senior Medical Accountant – Nairobi

Role Purpose

Responsible for timely, accurate, and fair resolution of medical claims disputes between the insurer and
healthcare providers. The position involves thorough review of unpaid or partially paid claims, identifying gaps or discrepancies, engaging providers to reach mutual agreements, and ensuring that correct payments are made in line with company policies and service agreements.

Key Responsibilities

Strategy

1. Contribute insights to the development of reconciliation strategies and process improvements based on claims data and provider trends.
2. Identify systemic issues contributing to unreconciled claims and recommend long-term solutions to
   management.
3. Support the Head of Reconciliation in strategic decision-making through timely escalation of high-impact cases and trends.
   

Operational

1. Review and analyze outstanding or unreconciled medical claims to determine root causes.
2. Liaise with healthcare providers to discuss and negotiate disputed claims, ensuring mutual understanding and resolution.
3. Perform accurate account reconciliations for designated providers, ensuring balances reflect agreed
   outcomes.
4. Maintain detailed records of communication and agreements reached with providers.
5. Collaborate with claims, finance, underwriting, and provider relations teams to ensure seamless case
   resolution.
6. Prepare periodic reports detailing reconciliation status, key metrics, and unresolved items.
   

Corporate Governance

1. Ensure all claim reviews and reconciliations adhere to internal policies, SHI/SHA and IRA regulations, and provider contract terms.
2. Confirm alignment of claim outcomes with benefit entitlements and contractual tariffs.
3. Support internal and external audits by providing necessary documentation and reconciliation trials.
4. Enforce strict confidentiality and data protection practices when handling member and provider
   information.