WANJIRU KELVIN HIUHU
Provider Contracting Senior Analyst
NAIROBI,47
Summary
Senior analyst with robust background in data analysis, financial modeling, and strategic planning. Known for strong collaboration skills and adaptability in fast-paced environments. Adept at leveraging advanced analytical tools and methodologies to drive impactful business decisions. Consistently delivers results through teamwork and solutions-focused approach.
Overview
13
13
years of professional experience
Work History
Provider Contracting Senior Analyst
CIGNA INTERNATIONAL HEALTH INSURANCE
12.2022 - Current
- Responsible to enable an effective and efficient collaboration with health provider in the region through monitoring and analyzing the results of the reconciliation of the accounts fulfilled by the Global Provider Reconciliation team
- Efficient and clear communication with health care providers on the results of the conducted accounts revision
- Comprehensive support on their interpretation and assurance of further follow up if needed
- Root cause analysis of the data obtained and consolidated feedback to Global Provider Services management team striving for continuous service delivery improvement through BAU collaboration with different teams
- Participation in coordination sessions with Network and Operations teams seeking for better practices in order to prevent service deficiencies and assure 5 star experience to health care providers
- Prompt follow up on potential risks in the region and proactive prevention of complaints related to reconciliation of the accounts coordinating the enhanced workflow with Global provider services management team
- Support the Global Provider Services management to determine short-, middle- and long-term solutions for smooth reconciliation process with Providers by continuously analyzing the intake of queries and complaints, as well as conducting reviews of the current processes for potential improvements
- Being a person of contact for Provider Network team in terms of escalations, complaints and any reported operational issues related to reconciliation process
- Deliver on operational KPI’s within the Global Provider reconciliation team in terms of production, quality, TAT, amongst others
- Collaborated with cross-functional teams to identify areas of improvement, leading to increased operational effectiveness.
- Mentored junior analysts, fostering professional development while enhancing overall team performance.
- Improved company efficiency with the development of key performance indicators and tracking metrics.
- Enhanced team productivity by streamlining workflow processes and implementing time-saving strategies.
- Optimized project management, resulting in timely deliverables and improved client satisfaction rates.
Senior Claims Representative
Cigna Healthcare
09.2019 - 11.2022
- Improved team productivity by providing ongoing training and support to junior claims representatives.
- Reduced backlog of pending claims by introducing an effective triage system based on priority levels.
- Analyzed complex claims data, identifying trends, and recommending improvements to reduce future risks.
- Collaborated with legal and medical professionals to gather necessary information for claim assessments.
- Enhanced customer satisfaction with timely and accurate resolution of claims disputes.
- Actively contributed to continuous improvement initiatives within the organization aimed at refining claims handling procedures and customer service standards.
- Assisted in the development of updated internal guidelines for handling specific types of claims cases.
Senior Claims Representative
Executive Healthcare Sol. (Aetna)
01.2015 - 12.2019
- Improved team productivity by providing ongoing training and support to junior claims representatives.
- Reduced backlog of pending claims by introducing an effective triage system based on priority levels.
- Analyzed complex claims data, identifying trends, and recommending improvements to reduce future risks.
- Collaborated with legal and medical professionals to gather necessary information for claim assessments.
- Actively contributed to continuous improvement initiatives within the organization aimed at refining claims handling procedures and customer service standards.
- Enhanced customer satisfaction with timely and accurate resolution of claims disputes.
- Increased company profits by minimizing fraudulent activities through diligent research and validation of claim details.
- Assisted in the development of updated internal guidelines for handling specific types of claims cases.
- Collaborated with legal department on important claims.
- Participated in cross-functional teams to evaluate organizational processes related to claims management, resulting in systemic enhancements.
- Developed strong relationships with insurance providers, promoting effective communication for claim resolution.
- Provided exceptional customer service when addressing inquiries from clients regarding their claim status or policy coverage details.
- Conducted thorough investigations of disputed claims, gathering evidence to support decision-making processes.
- Reduced claims processing time by implementing efficient workflow and prioritizing tasks.
- Expedited the approval process for genuine claims, maintaining a high level of trust among policyholders.
- Streamlined claims documentation process, ensuring completeness and accuracy for faster approvals.
- Managed a large caseload while maintaining strict deadlines and delivering consistent results under pressure situations.
- Negotiated fair settlements with claimants, contributing to favorable outcomes for all parties involved.
Claims Administrator
Executive Healthcare Sol. (Aetna)
01.2012 - 12.2015
- Supported continuous improvement efforts by identifying opportunities for process enhancements in the claims handling process.
- Balanced workload effectively, prioritizing tasks to ensure timely completion of all claim-related responsibilities.
- Reduced claim processing time by streamlining workflows and implementing efficient practices.
- Stayed updated with industry regulations, ensuring compliance in all claim-handling procedures.
- Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.
- Contributed to risk management strategies by identifying trends in claim types or emerging risks requiring further investigation.
- Monitored team performance, enforcing compliance with corporate claims processes and procedures.
- Participated in ongoing training sessions to stay current on industry trends and best practices.
- Negotiated settlements within approved authority limits to achieve fair outcomes for both customers and the company.
- Ensured timely claim payments by diligently monitoring deadlines and following up on outstanding documents.
- Expedited large-volume claim resolutions, coordinating closely with adjusters and other stakeholders involved in the process.
- Achieved faster resolution times with proactive follow-ups on pending documentation from policyholders or providers.
- Maintained comprehensive records of claims processed, facilitating quick retrieval for audits and reviews.
Education
FUNDAMENTALS OF INSURANCE PRACTICE, HEALTH INSURANCE
College of Insurance
Nairobi, Nairobi Province, Kenya12.2019
Certified Public Accounts Examination Section 3 - FINANCIALREPORTING,FINANCIAL MANAGEMENT,COMPANY LA
KASNEB
Nairobi, Nairobi Province, Kenya12-2015
Certified public accounts examination section two, part one - ECONOMICS, COST ACCOUNTING, AUDITING AND ASSURANCE
VISIONS INSTITUTE
06.2011
Certified public accounts examination section one, part one - INTRODUCTION TO LAW, ENTREPRENEURSHIP AND COMMUNICATION, FINANCIAL ACCOUNTING
VISIONS INSTITUTE
12.2010
Kenya Certificate of Secondary Education - Four Year Cycle in Secondary Education.
J G Kiereini High School
Kiambu, Kiambu District, Kenya11.2009
Skills
- Client management
- Client relationship management
- Performance monitoring
- Report preparation
- Advanced Excel
- Tech-Savvy
- MS Excel
- Process improvements
- Deadline adherence
- Team collaboration and leadership
- Root-cause analysis
- Account reconciliation
- Documentation and reporting
- Excel proficiency
- Attention to detail
- Time management
- Decision-making
- Microsoft office
Profile
Dynamic individual with hands-on experience in Provider relations,Reconciliation,data analysis and a talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals.
Timeline
Provider Contracting Senior Analyst
CIGNA INTERNATIONAL HEALTH INSURANCE
12.2022 - Current
Senior Claims Representative
Cigna Healthcare
09.2019 - 11.2022
Senior Claims Representative
Executive Healthcare Sol. (Aetna)
01.2015 - 12.2019
Claims Administrator
Executive Healthcare Sol. (Aetna)
01.2012 - 12.2015
Certified public accounts examination section two, part one - ECONOMICS, COST ACCOUNTING, AUDITING AND ASSURANCE
VISIONS INSTITUTE
Certified public accounts examination section one, part one - INTRODUCTION TO LAW, ENTREPRENEURSHIP AND COMMUNICATION, FINANCIAL ACCOUNTING
VISIONS INSTITUTE
FUNDAMENTALS OF INSURANCE PRACTICE, HEALTH INSURANCE
College of Insurance
Certified Public Accounts Examination Section 3 - FINANCIALREPORTING,FINANCIAL MANAGEMENT,COMPANY LA
KASNEB
Kenya Certificate of Secondary Education - Four Year Cycle in Secondary Education.
J G Kiereini High School
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