Principal Claims Management Officer Job SHA

Principal Claims Management Officer Job

Minimum Qualifications: Bachelor’s Degree

Job Term: Permanent and Pensionable

Position Level: SHA 5

Remuneration:

Kes. 164,710 x 8,230 – 172,940 x 8,657 – 181,597 x 9,078 – 190,675 x 9,528 – 200,204 x 9,258 – 210,218 x 10,014 –220,729 x 11,032 – 231,761 x 11,587 – 243,348 x 12,172 – 255,521 x 12,775 – 268,295 x 13,418 – 281,714 pa.
House Allowance: Kes 45,000/=, Commuter Allowance: Kes 17,000/=, Entertainment Allowance: Kes 3,750/=

Number of positions: 15

Qualifications, Skills and Experience Required:

Promotional-Claims Management-Medical Review: 

• Cumulative period of services of nine (9) years of work experience, three (3) of which should have been at the grade of Senior Claims Management Officer or in a comparable position.
• Bachelor’s Degree in Medicine and Surgery from a recognized institution.
• A valid practicing license.
• Certificate in Management course lasting not less than four (4) weeks from a recognized institution.
• Membership to the relevant professional body and in good standing.
• Proficiency in computer applications.
• Shown merit and ability as reflected in work performance and results.

Responsibilities:

• Undertaking medical reviews and interpretation of medical reports.
• Undertaking reviewing, processing, and validating of medical claims from healthcare providers and facilities for accuracy and adherence to policies.
• Undertaking the appraisal of medical claims based on the benefit package to ensure fair and timely disbursement of funds.
• Implementing the issuance of pre-authorizations for access to healthcare services based on the benefit package to facilitate timely service provision.
• Collecting and analyzing data for the e-claims and case management system to enhance efficiency and accountability.
• Conducting quality assurance surveillance in respect of claims to ensure adherence to policies and detect irregularities.
• Carrying out sensitization of claimants on the consequences of submitting false and fraudulent claims to reduce fraudulent activities.
• Collecting and analyzing data for purposes of claim management to facilitate informed decision-making and continuous process improvement.
• Collating and analyzing of data for preparation of quarterly reports on claims for submission for transparency and accountability.
• Ensuring compliance with contractual obligations contracted and outsourced claims management services.

How to Apply

Applications can be submitted via either application portal https://recruitment.sha.go.ke/ or physically delivered to SHA building 10th floor by clearly marking the position applied for on the envelope.

How to submit online applications

• Create an account
• Complete your profile by filling in your details in all the relevant sections
• Click on the vacancies tab
• On the jobs list, click on View Details to access the details of a particular job
• At the bottom section of the job’s detail, click on Apply to submit your application

Physical applications should be addressed to:

The Chairperson
Social Health Authority
P. O Box 30443-00100
Ragati Road
NAIROBI

Interested candidates should submit their applications, including:

• A cover letter demonstrating suitability for the position.
• A detailed curriculum vitae.
• Copies of academic and professional certificates.
• Contacts of at least three professional referees.

Applicants must satisfy the requirements of Chapter Six of the Constitution of Kenya by submitting valid and current copies of the following:

• Certificate of Good Conduct from the Directorate of Criminal Investigations.
• Tax Compliance Certificate from the Kenya Revenue Authority.
• Clearance Certificate from the Higher Education Loans Board (HELB).
• Clearance Certificate from the Ethics and Anti-Corruption Commission (EACC).
• Report from a Credit Reference Bureau (CRB).

Apply by 19th August, 2025 by 5.00P.M