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Medical Claims Analyst at Fidelity Shield Insurance
JobSearch
Nairobi 🇰🇪 Kenya
Posted 1 day ago (29 Sep 2026) Deadline: 5 Oct 2026 Updated about 4 hours ago
How to Apply
Send your CV to the contact address provided in the job posting.
Job Description
The Medical Claims Analyst will assess medical claims for accuracy and eligibility, adjudicate inpatient and outpatient submissions, and ensure compliance with policy guidelines. The role also oversees quality control, manages vendor performance and provides expert support to providers and customers.
Qualifications & Requirements
- • Bachelor’s degree or Diploma in Nursing, Clinical Medicine or Healthcare Management
- • At least 7 years of experience in health insurance claims adjudication, including 2 years in quality assurance
- • Knowledge of medical terminology, ICD‑10, CPT and HCPCS coding
Required Skills
Responsibilities
- • Review and assess medical claims for accuracy, completeness and eligibility
- • Adjudicate inpatient and outpatient claims while verifying supporting information
- • Respond to provider and customer inquiries and resolve issues promptly
- • Oversee quality control processes and monitor third‑party vendor performance
- • Ensure compliance with policy terms, medical coding standards and regulatory requirements