Kelvin Hiuhu Wanjiru
Nairobi
Summary
Punctual Driver with unprecedented talents in truck operations, loading and unloading and route coordination. Experience in operating and driving various trucks to transport goods and materials. Committed to ensuring delivery within specified timeframes. And also
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
12
12
years of professional experience
Work History
Driver
Self Employed -Part Time
Nairobi
01.2021 - Current
- Stored passenger luggage and personal items with care for safety and security.
- Waited for passengers at designated high-volume locations such as airports and popular nightlife spots.
- Checked in with dispatch to determine schedule and planned pickups.
- Maximized passenger satisfaction by keeping vehicles in safe and clean operating condition.
- Arrived on time to customer appointments.
- Transported high-value clients with professionalism and discretion.
- Calculated rides costs, received money and returned change.
- Upheld high standards of cleanliness, sanitation and service.
- Followed road rules to protect passengers and prevent accidents.
- Managed preventive maintenance on vehicle to maintain optimal condition.
- Communicated frequently with dispatch to obtain new pickup information and share delays or other important details.
- Helped passengers with questions or area information such as points of interest and entertainment options.
- Maintained vehicle cleanliness to maximize passenger satisfaction.
- Minimized mechanical issues by adhering to vehicle maintenance schedule.
Senior Claims Representative
Cigna Health Services Kenya
Nairobi
09.2019 - Current
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Paid or denied medical claims based upon established claims processing criteria.
- Reviewed provider coding information to report services and verify correctness.
- Posted payments to accounts and maintained records.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Modified, updated and processed existing policies.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Reviewed Number patient cases per week and verified insurance coverage information.
- Managed large volume of medical claims on daily basis.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Reported policy changes and company conditions affecting customer satisfaction.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Verified client information by analyzing existing evidence on file.
- Generated, posted and attached information to claim files.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Maintained confidentiality of patient finances, records and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Medical Claims Processor
Aetna International
Nairobi
01.2012 - 08.2019
- Managed large volume of medical claims on daily basis.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Reviewed provider coding information to report services and verify correctness.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated accuracy and quality of data entered into agency management system.
- Directed claims negotiations within allowable limit of $Amount and supported successful litigations for advanced issues.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Synthesized data into comprehensive quarterly written reports for management.
- Researched claims and incident information to deliver solutions and resolve problems.
- Examined claims forms and other records to determine insurance coverage.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Education
Certificate Of Proficiency - Insurance And Risk Management
College of Insurance
Nairobi 11.2020
Certified Public Accountants - Financial Management, Reporting And Audit
KASNEB
Nairobi 12.2012
Skills
- City and non-city driving
- Commercial driving
- Route logs
- GPS and route planning
- Equipment monitoring
- Transportation
- Shipping and packaging
- Processes and procedures
- Good Telephone Etiquette
- MS Office
- Excellent Communication
- Organization and Time Management
- Claims
- Claims review
- Microsoft Word
- Benefits review
- Insurance policy coverage knowledge
- Familiar with fraud statutes
- Healthcare Common Procedures Coding System (HCPCS)
- ClaimsPro
- Microsoft Office Suite
- Data security procedures
- Knowledgeable in Software
- Health insurance industry knowledge
- Medical terms and procedure knowledge
- Thorough claims reviews
- Insurance claims processing
- Telephone etiquette
- Insurance industry experience
- Reporting skills
- Understanding of medical terms
- Data integrity
- Account management
Timeline
Driver
Self Employed -Part Time
01.2021 - Current
Senior Claims Representative
Cigna Health Services Kenya
09.2019 - Current
Medical Claims Processor
Aetna International
01.2012 - 08.2019
Certificate Of Proficiency - Insurance And Risk Management
College of Insurance
Certified Public Accountants - Financial Management, Reporting And Audit
KASNEB
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