CLEMENT SHIKANDA
Nairobi, Nairobi Province
Summary
Accomplished Claims Officer with a proven track record at JUJA ROAD MATERNITY HOSPITAL, excelling in claims analysis and customer service. Demonstrated ability to manage high caseloads, achieving efficient settlements and enhancing customer satisfaction. Skilled in Microsoft Office and teamwork, adept at improving operational efficiency by over 30% through effective problem-solving and multitasking.
Overview
2
2
years of professional experience
Work History
Claims Officer
JUJA ROAD MATERNITY HOSPITAL
07.2024 - Current
- Managed high caseload efficiently, prioritizing tasks based on urgency and importance to meet deadlines consistently.
- Negotiated fair settlements with policyholders while maintaining positive relationships between the company and clients involved in disputes.
- Expedited claim resolution with prompt negotiation, evaluation, and settlement of claim amounts.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Invoicing/ Billing.
- Submission of medical claims to respective insurances.
- Reconciliation of Insurance claims and payments.
- Following up on payments from respective insurances.
- Customer care services (Handling client’s Complaints and Queries).
- Physical and System filing of patients’ documents.
- Reversing and updating revenues from wrong Accounts.
- Balancing the revenue receipt slips on the system.
- Filling receipts according to their year, date and the bank.
- Filling of Rejected Claims both physical and in the system.
Medical Receptionist
EQUITY AFIA KASARANI
06.2023 - 06.2024
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Checked patient insurance, demographic, and health history to keep information current.
- Helped patients complete necessary medical forms and documentation.
- Maintained strict confidentiality of patient information, adhering to HIPAA regulations and medical office policies.
- Billing of hospital bills.
- Submission of medical claims to respective insurances.
- Reconciliation of Insurance claims.
- Claiming medical claims from insurance companies.
- Biometric registration of patients.
Intern
National Hospital Insurance Fund
02.2023 - 04.2023
- Supported staff members in their daily tasks, reducing workload burden and allowing for increased focus on higher-priority assignments.
- Gained valuable experience working within a specific industry, applying learned concepts directly into relevant work situations.
- Sorted and organized files, spreadsheets, and reports.
- Gained hands-on experience in various software programs, increasing proficiency and expanding technical skill set.
- Managing daily administrative tasks.
- Receiving Hospital claims.
- Checking claims both physical and in the system.
- Filling of Rejected Claims both physical and in the system.
- Undertaking Audit Surveillance to all accredited hospitals under Ruaraka Branch.
- Receiving, recording and capturing of members’ registration forms.
- Customer care services (Handling client’s Complaints and Queries).
- Physical and System filing of Registration and Amendment forms.
- Retrieving posted revenue.
- Updating existing members’ details and dependants in the system.
- Reversing and updating revenues from wrong Accounts.
- Balancing the revenue receipt slips on the system.
- Filling receipts according to their year, date and the bank.
- Biometric registration of members.
Education
Bachelor of Commerce - Finance
KCA University
11.2024
Skills
- Claims analysis
- Technical knowledge
- Investigation techniques
- Policy Interpretation
- Claims Investigation
- Teamwork and Collaboration
- Customer Service
- Problem-Solving
- Multitasking
- Microsoft Office
- Data Entry
- Professionalism
- Documentation abilities
- Insurance Claim Forms Review
- Insurance Coverage Verification
- Denied claims identification
- Claim Amount Calculations
- Billing Software
- Regulatory Compliance Adherence
Timeline
Claims Officer
JUJA ROAD MATERNITY HOSPITAL
07.2024 - Current
Medical Receptionist
EQUITY AFIA KASARANI
06.2023 - 06.2024
Intern
National Hospital Insurance Fund
02.2023 - 04.2023
Bachelor of Commerce - Finance
KCA University
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