Britam is a leading diversified financial services group offering a wide range of financial products and services in insurance, asset management, banking, and property. With operations in Kenya and across the East African region, Britam has built a reputation for innovation, customer-centric solutions, and professional excellence. As part of our continuous commitment to offering top-notch services and ensuring operational efficiency, we are seeking to fill the position of Medical Claims Assistant. This role presents a unique opportunity for a professional who is passionate about client service and medical claims management to be part of a forward-thinking and dynamic organization.
If you are seeking a rewarding and challenging opportunity where your attention to detail, analytical skills, and dedication to service excellence will be appreciated and nurtured, this may be the role for you.
Position: Medical Claims Assistant
Job Reference: 2500002P
Job Type: Permanent
Shift: Day Job
Contract Type: Full-time
Primary Location: Nairobi, Kenya
Organization: Britam
Job Posting Date: 16th June 2025
Unposting Date: Ongoing
Number of Openings: 1
Job Purpose
The Medical Claims Assistant is a vital component of the claims processing team within Britam. This role is responsible for delivering excellent client service by accurately processing and paying medical claims under Britam Connect, analyzing claims data, compiling detailed reports, and ensuring adherence to internal and external guidelines. The position plays a significant role in enhancing customer experience, maintaining service quality, and ensuring cost control mechanisms are followed.
Key Responsibilities
The responsibilities of the Medical Claims Assistant include but are not limited to:
Claims Processing and Payments
- Process claims and ensure accurate payment to both service providers and clients.
- Ensure that all medical and non-medical claims are correctly assessed and aligned with policy terms.
- Review all claims documentation thoroughly to confirm completeness and validity.
Data Analytics and Reporting
- Analyze claims data to identify trends and generate actionable insights.
- Compile detailed, timely, and accurate reports for internal use and decision-making.
- Participate in continuous improvement processes through data-backed recommendations.
Communication and Coordination
- Liaise with clients and healthcare providers to validate that services rendered are within coverage limits.
- Engage underwriters for clarification regarding coverage for specific schemes.
- Provide advisory support to clients regarding claims procedures and policy coverage.
Compliance and Documentation
- Scrutinize medical reports and submitted claims for adherence to insurance and clinical guidelines.
- Promote use of cost-effective solutions such as generic medication where appropriate, based on analytics.
- Validate and verify submitted documents to maintain integrity in the claims process.
Relationship Management
- Maintain strong and effective relationships with clients, intermediaries, and healthcare providers.
- Ensure that customer experience remains positive through timely updates and efficient resolution of issues.
Claims Auditing and Risk Mitigation
- Perform audits on both outpatient and inpatient claims to reduce financial and operational risks.
- Detect and escalate any anomalies in claims to safeguard the company’s financial interests.
Record Keeping and Administration
- Maintain accurate, up-to-date records of all claims transactions.
- Prepare and update claims registers and relevant documentation for periodic claims meetings.
- Monitor and follow up on pending claims documentation to ensure swift processing.
Training and System Support
- Offer training and guidance to service providers on systems and claims procedures to enhance collaboration.
- Ensure all service providers understand the documentation and policy requirements for claims submission.
Internal and External Support
- Respond effectively to queries from both internal departments and external clients on claims processing, required documentation, and approved service providers.
- Support internal teams with data and insight to facilitate broader organizational goals.
Delegated Authority
This role operates within the defined responsibilities and limits set out in the approved Delegated Authority Matrix. The holder is expected to make decisions and take actions in line with company policy and delegated authority.
Required Knowledge, Experience, and Skills
- A Bachelor’s degree in Actuarial Science, Data Science, Computer Science, or an equivalent discipline.
- Strong data analytics skills will be particularly desirable.
- A minimum of 1 year of experience in medical claims processing and claims data analytics.
Why Join Britam?
Britam is committed to nurturing talent, promoting innovation, and delivering superior customer value. Joining Britam means you will be part of an organization that values professionalism, integrity, performance excellence, and continuous learning. Our employees are our greatest asset, and we invest in their development and well-being. This position provides a platform to work within a high-performing team, learn from industry leaders, and contribute to the growth of the health insurance business.
Application Instructions
To be considered for this role, ensure that your application includes an updated CV and a cover letter detailing your experience and suitability for the role of Medical Claims Assistant. Kindly submit your application through the appropriate application channel provided by Britam.
Applications should be submitted via email as instructed.
