Medical Claims Officer
2025-06-07T19:45:18+00:00
Marie Stopes Tanzania ( MST )
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https://www.mariestopes.or.tz/
FULL_TIME
11 Majuva Street – Mwenge P. O. Box 7072, Dar Es Salaam
Dar es Salaam
Dar es Salaam
00000
Tanzania
Healthcare
Healthcare
2025-06-14T17:00:00+00:00
Tanzania
8
Job Summary:
We are seeking a qualified and detail-oriented Medical Claims Officer to join our insurance and billing team. The ideal candidate will have a medical background (Clinical Officer or Medical Doctor) and experience in medical claims vetting & adjudication, particularly within the Tanzanian healthcare and insurance landscape. This role ensures accurate, compliant, and timely submission of medical claims both manually and through online platforms to insurance providers.
Key Responsibilities:
- Review and vet inpatient and outpatient claim for accuracy, completeness, and compliance with Tanzanian insurance policies and guidelines.
- Submit claims electronically via NHIF and private insurance portals, ensuring timely and accurate data entry.
- Monitor online/physical claim submissions for rejections, errors, or delays and take corrective actions promptly.
- Evaluate clinical documentation to ensure medical necessity and appropriate coding align with the Tanzania Standard treatment guideline.
- Ensure all claims meet compliance standards set by the Ministry of Health, NHIF, and private insurers.
- Liaise with receptionist, clinician, laboratory, pharmacy and billing teams to ensure compliance is achieved.
- Follow up on pending, denied/rejected, or underpaid claims and coordinate reconciliation with insurers.
- Maintain accurate records of claims, correspondence, and payment statuses for each insurance.
- Provide training and support to clinical and administrative staff on documentation and claims best practices.
- Generate regular reports on claims performance, rejections, and trends for internal audits and management review.
- Stay updated on changes in insurance regulations, NHIF policies, and healthcare compliance requirements in Tanzania.
Qualifications:
- Medical degree or Diploma in Clinical Medicines mandatory.
- Certificate Diploma or Degree any field of insurance will be added advantage.
- Minimum 2–5 years of experience medical claims vetting or healthcare insurance in Tanzania.
- Registered with Medical council of Tanganyika.
- Strong understanding of Tanzanian healthcare system, NHIF processes, and private insurance operations.
- Familiarity with hospital billing systems, electronic health records, and online claims platforms.
- Excellent analytical, communication, and problem-solving skills.
- Ability to work independently and collaboratively in a fast-paced environment.
Preferred Skills:
- Certification in medical coding (e.g., ICD-10) is an added advantage.
- Experience with e-claims portal and private insurer platforms.
- Knowledge of Tanzanian healthcare compliance and audit procedures.
Review and vet inpatient and outpatient claim for accuracy, completeness, and compliance with Tanzanian insurance policies and guidelines. Submit claims electronically via NHIF and private insurance portals, ensuring timely and accurate data entry. Monitor online/physical claim submissions for rejections, errors, or delays and take corrective actions promptly. Evaluate clinical documentation to ensure medical necessity and appropriate coding align with the Tanzania Standard treatment guideline. Ensure all claims meet compliance standards set by the Ministry of Health, NHIF, and private insurers. Liaise with receptionist, clinician, laboratory, pharmacy and billing teams to ensure compliance is achieved. Follow up on pending, denied/rejected, or underpaid claims and coordinate reconciliation with insurers. Maintain accurate records of claims, correspondence, and payment statuses for each insurance. Provide training and support to clinical and administrative staff on documentation and claims best practices. Generate regular reports on claims performance, rejections, and trends for internal audits and management review. Stay updated on changes in insurance regulations, NHIF policies, and healthcare compliance requirements in Tanzania.
Certification in medical coding (e.g., ICD-10) is an added advantage. Experience with e-claims portal and private insurer platforms. Knowledge of Tanzanian healthcare compliance and audit procedures.
Medical degree or Diploma in Clinical Medicines mandatory. Certificate Diploma or Degree any field of insurance will be added advantage. Minimum 2–5 years of experience medical claims vetting or healthcare insurance in Tanzania. Registered with Medical council of Tanganyika. Strong understanding of Tanzanian healthcare system, NHIF processes, and private insurance operations. Familiarity with hospital billing systems, electronic health records, and online claims platforms. Excellent analytical, communication, and problem-solving skills. Ability to work independently and collaboratively in a fast-paced environment.
JOB-684496cea5c74
Vacancy title:
Medical Claims Officer
[Type: FULL_TIME, Industry: Healthcare, Category: Healthcare]
Jobs at:
Marie Stopes Tanzania ( MST )
Deadline of this Job:
Saturday, June 14 2025
Duty Station:
11 Majuva Street – Mwenge P. O. Box 7072, Dar Es Salaam | Dar es Salaam | Dar es Salaam | Tanzania
Summary
Date Posted: Saturday, June 7 2025, Base Salary: Not Disclosed
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JOB DETAILS:
Job Summary:
We are seeking a qualified and detail-oriented Medical Claims Officer to join our insurance and billing team. The ideal candidate will have a medical background (Clinical Officer or Medical Doctor) and experience in medical claims vetting & adjudication, particularly within the Tanzanian healthcare and insurance landscape. This role ensures accurate, compliant, and timely submission of medical claims both manually and through online platforms to insurance providers.
Key Responsibilities:
- Review and vet inpatient and outpatient claim for accuracy, completeness, and compliance with Tanzanian insurance policies and guidelines.
- Submit claims electronically via NHIF and private insurance portals, ensuring timely and accurate data entry.
- Monitor online/physical claim submissions for rejections, errors, or delays and take corrective actions promptly.
- Evaluate clinical documentation to ensure medical necessity and appropriate coding align with the Tanzania Standard treatment guideline.
- Ensure all claims meet compliance standards set by the Ministry of Health, NHIF, and private insurers.
- Liaise with receptionist, clinician, laboratory, pharmacy and billing teams to ensure compliance is achieved.
- Follow up on pending, denied/rejected, or underpaid claims and coordinate reconciliation with insurers.
- Maintain accurate records of claims, correspondence, and payment statuses for each insurance.
- Provide training and support to clinical and administrative staff on documentation and claims best practices.
- Generate regular reports on claims performance, rejections, and trends for internal audits and management review.
- Stay updated on changes in insurance regulations, NHIF policies, and healthcare compliance requirements in Tanzania.
Qualifications:
- Medical degree or Diploma in Clinical Medicines mandatory.
- Certificate Diploma or Degree any field of insurance will be added advantage.
- Minimum 2–5 years of experience medical claims vetting or healthcare insurance in Tanzania.
- Registered with Medical council of Tanganyika.
- Strong understanding of Tanzanian healthcare system, NHIF processes, and private insurance operations.
- Familiarity with hospital billing systems, electronic health records, and online claims platforms.
- Excellent analytical, communication, and problem-solving skills.
- Ability to work independently and collaboratively in a fast-paced environment.
Preferred Skills:
- Certification in medical coding (e.g., ICD-10) is an added advantage.
- Experience with e-claims portal and private insurer platforms.
- Knowledge of Tanzanian healthcare compliance and audit procedures.
Work Hours: 8
Experience in Months: 24
Level of Education: associate degree
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