Clinical Officer – Claims & Billing Specialist

About the role

The Clinical Officer will review patient files and invoices to ensure that diagnoses, treatments, medicines and investigations are clinically justified and that all claims are accurately prepared and submitted.

Key responsibilities

• Review patient files and invoices to ensure diagnoses, treatments, medicines and investigations are clinically justified.
• Apply correct ICD-10 coding and ensure claims meet each insurer’s requirements.
• Prepare, submit and follow up claims with NHIF and private insurers such as Jubilee, Strategis, Assemble, Henner, Britam.
• Investigate rejected and short‑paid claims, correct them and resubmit promptly.
• Reconcile insurer payments and remittance advices against outstanding claims.
• Handle clinical queries from insurers and liaise with doctors when documentation is missing or unclear.
• Identify recurring causes of rejection and train front‑desk, clinical and pharmacy staff to prevent them.
• Prepare regular reports on claims status, rejections and ageing receivables.

Required profile

• Diploma or Degree in Clinical Medicine.
• Registered with the Medical Council of Tanganyika (MCT).
• At least 3 years’ experience, including work in a healthcare receivables, billing or insurance claims department.
• Strong understanding of NHIF and private insurance claim processes, pre‑authorisations and common rejection reasons.
• Working knowledge of ICD-10 coding.
• Computer literate, proficient in Excel; experience with ERP or hospital systems is an advantage.
• Attention to detail, integrity and ability to meet deadlines.
• Good communication skills in English and Kiswahili.

Required skills

• ICD-10 coding
• Microsoft Excel
• ERP or hospital information systems (experience)