Nurse/Midwife

Education

• Hold a Degree in Medicine and Surgery from a recognized university/ (medical training) college with a minimum of 2 years’ experience.
  
• Hold a valid active practicing license from the Kenya Medical Practitioners and Dentists Board.
  
• A master’s degree will be an added advantage.
  

Experience

• Position holder should have at least 2 years’ experience working as a licensed Medical Officer in a busy maternity institution and experience in working in a startup maternity facility.
  
• Neonatal/Paediatric or reproductive health experience is an added advantage.
  
• Knowledge and Skills Requirements
  
• Strong communication and interpersonal skills.
  
• Excellent analytical reasoning skills and meticulous attention to detail.
  
• Computer literacy, with proficiency in Microsoft Office Suite.
  

Claims Management

• Collect, verify, and prepare insurance claims with supporting documents (invoices, pre-authorizations, medical reports);
  
• Submit claims to insurers within stipulated timelines and monitor acknowledgment of receipt;
  
• Track claims at every stage to ensure timely settlement;
  
• Maintain an updated claims register with details of claims submitted, amounts, dates, and statuses;
  

Reconciliation & Payment Processing

• Reconcile insurer remittances against submitted claims, ensuring accuracy and completeness;
  
• Investigate and resolve variances, rejections, partial payments, or delays in settlement;
  
• Prepare reconciliation statements and submit to the Finance Manager;
  
• Work with Accounts Receivable to ensure insurance payments are correctly posted;
  

Follow-Up & Dispute Resolution

• Liaise with insurance companies and third-party administrators to resolve disputed or pending claims;
  
• Escalate unresolved claim issues to management for intervention;
  
• Maintain strong working relationships with insurer contacts to facilitate quick resolution;
  

Compliance & Risk Management

• Ensure all claims adhere to hospital policies, insurer requirements, and regulatory standards;
  
• Monitor and report on trends in claim rejections or denials, recommending preventive measures;
  
• Safeguard confidentiality of patient and insurer information in line with data protection regulations;
  

Reporting & Analysis

• Prepare periodic reports on claims submitted, amounts recovered, outstanding balances, and rejection trends;
  
• Provide management with insights on performance of different insurers and highlight areas of concern;
  
• Support preparation of monthly, quarterly, and annual financial reports related to insurance recoveries;
  

Stakeholder Coordination & Process Improvement

• Collaborate with clinical, billing, and administrative teams to ensure accurate patient data and claim documentation;
  
• Train or sensitize staff on proper documentation practices to reduce claim rejections;
  
• Recommend process improvements to reduce turnaround times and increase claim recovery efficiency;
  
• Keep updated with changes in insurance policies, tariffs, and regulations, and advise management accordingly;
  
• Any other duties as may be assigned.