Operations and Claims Manager

Our client, a hospital in Limuru, is seeking a Operations & Claims Manager to be responsible for coordinating the day-to-day non-clinical operations of the hospital while overseeing the complete medical claims and revenue-cycle process.

The role ensures that hospital departments operate efficiently, patients receive timely and coordinated services, operational resources are properly utilized, and claims submitted to SHA, insurance companies, corporate clients and other payers are accurate, complete, compliant and followed through to payment.

The position acts as a key link between clinical departments, front office, finance, insurers, SHA, corporate clients and hospital management.

KEY RESPONSIBILITIES:

1. Hospital operations management
2. Patient experience and service delivery
3. SHA Claims management
4. Private insurance claims
5. Corporate client accounts
6. Claims quality control
7. Revenue cycle management
8. Staff coordination
9. Compliance and documentation
10. Reporting

Minimum Qualifications:

- Bachelor's degree or diploma in Business Administration, Healthcare Management, Finance, Accounting, Management or a related field.
- At least 3 years' relevant experience in hospital operations, medical claims, insurance administration or healthcare revenue-cycle management.
- Demonstrated experience handling medical insurance claims.
- Experience with SHA claims management will be a strong advantage.
- Experience working in a hospital or healthcare facility is highly desirable.
- Good knowledge of hospital billing processes and medical insurance procedures.
- Strong Microsoft Excel skills.
- Experience using a Hospital Management Information System (HMIS).
- Good understanding of medical terminology and clinical documentation.
- Strong analytical and problem-solving skills.
- Good interpersonal, communication and negotiation skills.

Working Relationships

Internal:
Hospital Management, Medical Officers, Clinical Officers, Nurses, Finance Department, Front Office, Pharmacy, Laboratory, Radiology, Health Records, HR, Procurement and other support departments.

External:
Social Health Authority, insurance companies, medical scheme administrators, corporate clients, brokers, regulators, suppliers and other healthcare partners.

Disclaimer: By applying for this role, you are consenting to us processing your data for decision-making