Medical Senior Claims Officer
CIC Insurance
Job Type
Full Time
Category
Medical
Monthly Salary
Not Specified
Deadline
30th September 2025
Location
Kampala
About CIC Insurance
As a subsidiary of CIC Insurance Group (PLC), we have enabled Ugandans attain financial security over the last ten years through provision of our range of customized financial and insurance solutions. The experience spanning more than 5 decades operating in the East African region that include Kenya, Uganda Malawi and South Sudan has ensured provision of exemplary services to our customers in Uganda.
The company has also registered commendable growth and expansion over the last decade and established successful subsidiaries in the insurance industry comprising of CIC General Insurance (U) Ltd and CIC Africa Life Assurance Ltd. Our two business have reliably cushioned individuals, cooperatives, public and private sectors through the provision of insurance services to help mitigate risks against themselves, their businesses as well as help with planning for life events at varied stages.
The company ownership is structured along the principle of mutuality, which is aptly demonstrated through a significant ownership of the business being set aside specifically for cooperatives. Through this arrangement, we ensure that our service provision is well cut out to ensure the benefits trickle down to the lowest levels of our society, and that profit maximization is realized not only through policyholder benefits but also through shareholder returns.
Our wide range of insurance packages protect our clients’ businesses giving them peace of mind to grow their wealth and achieve their financial goals. In all we do, we keep our word.
The company has also registered commendable growth and expansion over the last decade and established successful subsidiaries in the insurance industry comprising of CIC General Insurance (U) Ltd and CIC Africa Life Assurance Ltd. Our two business have reliably cushioned individuals, cooperatives, public and private sectors through the provision of insurance services to help mitigate risks against themselves, their businesses as well as help with planning for life events at varied stages.
The company ownership is structured along the principle of mutuality, which is aptly demonstrated through a significant ownership of the business being set aside specifically for cooperatives. Through this arrangement, we ensure that our service provision is well cut out to ensure the benefits trickle down to the lowest levels of our society, and that profit maximization is realized not only through policyholder benefits but also through shareholder returns.
Our wide range of insurance packages protect our clients’ businesses giving them peace of mind to grow their wealth and achieve their financial goals. In all we do, we keep our word.
Job Description
CIC Insurance is seeking a Medical Senior Claims Officer to ensure efficient and accurate processing, assessment, and settlement of medical insurance claims in line with company policies, regulatory requirements, and service standards while safeguarding the company against fraudulent or unjustified claims.
Responsibilities
- Receive, register, and acknowledge medical claims from healthcare providers and policyholders.
- Review and verify the completeness of claim documents and medical reports.
- Assess claims against policy terms, exclusions, and medical necessity.
- Recommend approval, rejection, or further investigation of claims.
- Ensure accurate calculation of claim amounts payable.
- Evaluate medical records and/or medical notes providing clinical expertise on coding accuracy.
- Vet each and every medical claim to ensure that it aligns with the insured life, as per age profile and the previous medical history.
- Vet/audit to ensure adherence to cost as pe CIC contracted rates and guidelines
- Liaise with medical service providers to confirm treatments, diagnoses, and procedures.
- Evaluate medical bills, prescriptions, and treatment plans for cost-effectiveness and compliance with policy limits.
- Identify and flag potential fraudulent or exaggerated claims.
- Review service provider reconciliations requests relating to claim edits and validation outcomes
- Review all medical underwriting notes for both individual and corporate scheme and offer advice on coverage on anticipated Risk.
- Provide healthcare consultations and technical advice by investigating malpractice claims, identifying and locating witnesses and experts, and preparing case notes and summations for attorneys and other team members.
- Respond to inquiries from clients, providers, and intermediaries on claim matters.
- Provide guidance to clients on claim requirements, processes, and timelines.
- Build and maintain strong relationships with hospitals, clinics, and medical practitioners.
- Efficiently communicate with claimants, physicians and other necessary individuals to decide claim denial, settlement or review.
- Ensure claims are processed in compliance with company policies, service level agreements, and regulatory guidelines.
- Maintain accurate records of all medical claims.
- Prepare periodic reports on claims performance, trends, and risks for management decision-making.
- Support internal and external audits by providing necessary documentation
- Support initiatives to streamline claims processes and reduce turnaround time.
- Participate in audits and recommend controls to minimize claim leakages.
- Stay updated on medical trends, treatments, and insurance industry practices.
Requirements
- Bachelor’s Degree in any Medical Field (added advantage)
- Diploma in Clinical Medicine or Nursing field
- Member of Uganda Nurses & Midwives Council
- Diploma in Insurance
- Minimum 4 years of relevant experience
- Clinical knowledge in medicine or nursing
- Understanding of insurance principles (if applicable)
- Strong interpersonal and communication skills
- Ability to work in a team and independently
- Problem-solving and decision-making skills
- Attention to detail and accuracy
- Commitment to ethical standards in healthcare
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