Claims Officer

ABOUT THE COMPANY Oasis Healthcare Group Limited was conceptualized out of the need to harmonize the various companies and facilities existing across the country under the Oasis umbrella that have been in existence since 2010. In the wisdom of the founder members of all these outfits, there was need to synchronize the strategic direction, standard operating procedures, business processes, expansion programmes, style, systems and shared values among others. This was compounded by the need to have a centralized control or ‘command’ and harness on opportunities in the local as well as global arena through product differentiation and diversification together with capital sourcing. The Company is envisioned to a suitable regional ‘hub’ model.

OHGL subsidiaries are made up of skilled and dedicated health specialists, professionals, support staff, volunteers and physicians who promote wellness, prevent disease and injury, and provide healthcare every day to a diverse population in Kenya, especially those living in urban centres. OHGL is Kenya’s first and largest countrywide, fully-integrated private health system. The creation of OHGL supports consistent access to health services and standards and better coordination of services across the Kenya and beyond. JOB SUMMARY Skill & ExperienceDiploma in Accounting, Finance, or a related business field.Minimum of 2 years’ experience in hospital billing or insurance claims management.Strong understanding of healthcare billing systems and claim processing procedures.Knowledge of SHA and private insurance claim guidelines.Proficiency in Microsoft Excel and hospital management systems.Strong analytical and reconciliation skills.High level of accuracy and attention to detail.Good negotiation and follow-up skills.Strong communication and interpersonal skills.Ability to work under pressure and meet strict submission deadlines. RESPONSIBILITIES Prepare, verify, and submit insurance claims (SHA and private insurers) accurately and within stipulated timelines.Review patient files to ensure completeness of documentation before claim submission.Reconcile claims submitted against payments received and identify variances.Follow up on pending, rejected, or partially paid claims to ensure timely reimbursement.Analyze claim rejection trends and recommend corrective measures.Liaise with insurers, corporate clients, and internal departments to resolve claim-related discrepancies.Maintain accurate claims records and update tracking systems regularly.Ensure compliance with insurer contracts, pre-authorization requirements, and billing guidelines.Support revenue cycle management by coordinating with billing, pharmacy, laboratory, and clinical departments.Generate periodic claims performance reports (submission rates, rejection rates, aging analysis).Assist in preparing documentation required for insurer audits and reconciliation meetings.Monitor credit control and aging of receivables from insurance and corporate accounts.Ensure c