The Authority is inviting applications for the position of Senior Claims Management Officer. This is an excellent opportunity for skilled and experienced professionals to join a dynamic team committed to ensuring efficiency, accountability, and quality in claims management.
This recruitment exercise is one of the largest in recent years, with 96 positions available across the country. Successful candidates will be employed on permanent and pensionable terms, ensuring long-term job security and career growth.
Applications are open to all qualified individuals, and the deadline for submission is October 3, 2025, at 5:00 p.m..
This role offers a chance to make a meaningful impact in the health sector by contributing to transparent, efficient, and customer-centered claims management processes.
Position Details
- Job Title: Senior Claims Management Officer
- Reference Number: SHA/185/2025
- Term: Permanent and Pensionable
- Number of Positions: 96
- Job Level: SHA 6
- Deadline: October 3, 2025, at 5:00 p.m.
Minimum Qualifications
- Bachelor’s Degree
- Valid practicing license where applicable
- Membership to a recognized professional body and in good standing
- Proficiency in computer applications
Experience Requirements
Promotional – Claims Management (Medical Review):
- At least three (3) years’ work experience at the grade of Claims Management Officer I or in a comparable position.
- Bachelor’s Degree in Medicine and Surgery from a recognized institution.
- Valid practicing license.
- Membership to the relevant professional body in good standing.
- Proven merit and ability in work performance and results.
Promotional – Claims Management:
- At least six (6) years’ cumulative service experience, three (3) of which must have been at the grade of Claims Management Officer I or in a comparable position.
- Bachelor’s Degree in Medicine, Nursing, Clinical Medicine, or Medicine and Surgery from a recognized institution.
- Membership to a recognized professional body in good standing.
- Proficiency in computer applications.
- Proven merit and ability in work performance and results.
Job Description and Responsibilities
Officers in this cadre may be deployed to one of three main functional areas: Claims Management (Medical Review), Claims Management, or County Coordination (Quality Assurance and Surveillance).
1. Claims Management (Medical Review)
In this function, Senior Claims Management Officers will:
- Conduct medical reviews of reports to ensure accuracy and completeness.
- Review, process, and validate medical claims from healthcare providers and facilities under supervision.
- Appraise claims based on the benefit package to determine eligibility and prevent misuse.
- Facilitate issuance of pre-authorizations for healthcare services to ensure compliance with procedures.
- Assist in operationalizing the e-claims management system to streamline claims processing.
- Collect and analyze data to enhance efficiency in claims processing.
- Sensitize claimants on the consequences of submitting fraudulent claims, reducing cases of fraud.
2. Claims Management
In this role, officers will be responsible for:
- Reviewing and processing medical claims from healthcare providers to ensure compliance.
- Appraising claims against benefit packages to ensure eligibility and fairness.
- Implementing pre-authorization processes to ensure timely access to healthcare services.
- Collecting and analyzing data to support the e-claims and case management system.
- Conducting quality assurance surveillance to detect irregularities and enforce compliance with policies.
- Leading sensitization programs to educate claimants on fraud prevention.
- Collating and analyzing data for the preparation of quarterly claims reports.
- Ensuring compliance with contractual obligations for contracted and outsourced claims management services.
3. County Coordination (Quality Assurance and Surveillance)
This area focuses on regional oversight and compliance, including:
- Conducting quality assurance surveillance to ensure adherence to claims management policies.
- Monitoring compliance with the Social Health Insurance Act (SHI Act), policies, and procedures at the branch level.
- Implementing operational standards to ensure efficient service delivery.
- Enforcing compliance with contractual agreements by healthcare providers.
- Supporting assessments for empanelment of healthcare providers.
- Preparing and maintaining updated records for empaneled healthcare facilities.
- Compiling data for compliance monitoring and benefit utilization.
- Establishing systems to detect and prevent fraud based on the Authority’s exposure and vulnerabilities.
- Conducting claimant sensitization to discourage false and fraudulent claims.
- Collecting and analyzing data for improved decision-making and continuous process improvement.
- Ensuring compliance with outsourced claims management services.
Why This Role Matters
The position of Senior Claims Management Officer is at the heart of ensuring fair, efficient, and transparent claims handling. By streamlining the claims process, validating medical claims, and preventing misuse of funds, officers in this cadre play a direct role in:
- Safeguarding the integrity of the healthcare financing system.
- Ensuring beneficiaries receive timely access to healthcare services.
- Supporting healthcare providers by enabling fair and accurate reimbursement.
- Reducing fraudulent claims and protecting public funds.
- Building confidence in the healthcare system through transparency and accountability.
This is not just a job; it is a chance to be part of a national effort to strengthen the healthcare financing system and improve service delivery across the country.
Career Growth and Benefits
Successful candidates will:
- Be employed on permanent and pensionable terms, offering stability.
- Gain opportunities for professional growth within the Authority.
- Work in diverse settings, from national offices to county coordination roles.
- Contribute to shaping a robust and transparent health claims system.
With 96 positions available, this recruitment drive provides a rare opportunity for qualified professionals to join a growing and impactful team.
Application Deadline
All applications must be submitted by October 3, 2025, at 5:00 p.m. Late applications will not be considered.
How to Apply
If you meet the outlined requirements and are passionate about driving efficiency and accountability in health claims management, you are encouraged to apply.
