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Jobs and Vacancies in Kampala, Uganda
213 jobs found
Action Against Hunger
Populations (AAP) / Prevention of Sexual Exploitation and Abuse (PSEA) Officer)
6 days left to apply
Posted: 11 Nov 2026
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CIC Insurance Group
Banking + 2 more
CLAIMS OFFICER – MEDICAL
Description
About the Role
Reporting to the Head of Medical, the role is responsible for assessment, processing and settlement of medical insurance claims by ensuring fairness, accuracy and compliance with company policies and industry regulations. It also ensures timely claims management, cost control and provides technical guidance to the medical team safeguarding the company against fraudulent or unjustified claims.
Key Responsibilities
Claims Processing & Assessment
- Receive, register, and acknowledge medical claims from healthcare providers and policyholders.
- Review and verify the completeness of claim documents and medical reports.
- Assess claims against policy terms, exclusions, and medical necessity.
- Recommend approval, rejection, or further investigation of claims.
- Ensure accurate calculation of claim amounts payable.
- Evaluate medical records and/or medical notes providing clinical expertise on coding accuracy.
- Vet each and every medical claim to ensure that it aligns with the insured life, as per age profile and the previous medical history.
Claims Review & Verification
- Liaise with medical service providers to confirm treatments, diagnoses, and procedures.
- Evaluate and authorize complex and high – value medical claims within delegated authority.
- Ensure claims decisions are based on policy terms, medical evidence and underwriting guidelines.
- Evaluate medical bills, prescriptions, and treatment plans for cost-effectiveness and compliance with policy limits.
- Identify and flag potential fraudulent or exaggerated claims.
- Review service provider reconciliations requests relating to claim edits and validation outcomes
- Review all medical underwriting notes for both individual and corporate scheme and offer advice on coverage on anticipated Risk.
- Provide healthcare consultations and technical advice by investigating malpractice claims, identifying and locating witnesses and experts, and preparing case notes and summations for attorneys and other team members.
Customer Service & Stakeholder Management
- Respond to inquiries from clients, providers, and intermediaries on claim matters.
- Provide guidance to clients on claim requirements, processes, and timelines.
- Build and maintain strong relationships with hospitals, clinics, and medical practitioners.
- Efficiently communicate with claimants, physicians and other necessary individuals to decide claim denial, settlement or review.
Compliance & Reporting
- Ensure claims are processed in compliance with company policies, service level agreements, and regulatory guidelines.
- Maintain accurate records of all medical claims.
- Prepare periodic reports on claims performance, trends, and risks for management decision-making.
- Support internal and external audits by providing necessary documentation.
- Provide feedback to underwriting and product teams on emerging risks and medical cost drivers.
Medical &Provider Liaison
- Coordinate with hospitals, clinics and medical practitioners for claim verifications.
- Negotiate costs and settlements with healthcare providers.
- Liaise with reinsurers for facultative claims and recoveries.
- Any other duties that may be assigned from time to time.
Who We’re Looking For
Qualifications
- Bachelor’s Degree in relevant field
- Uganda Registered Nursing (URN
- Minimum of 2-years’ experience
Key competencies
- Organized, detail-oriented, and able to work under tight timelines.
- Committed to professional growth and continuous learning.
- Good collaborator with good communication skills.
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