Claims Assistant at Britam Insurance
Company: Britam Insurance Tanzania Limited Job Reference: 2500004Y Location: Dar es Salaam, Tanzania Employment Type: Permanent, Full-time Shift: Day Job Application Deadline: 01 December 2025
About Britam Insurance
Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region, with operations in Kenya, Uganda, Tanzania, Rwanda, South Sudan, Mozambique, and Malawi. The group offers a wide range of financial products and services in Insurance, Asset Management, Banking, and Property.
In Tanzania, Britam Insurance Tanzania Limited is committed to providing innovative insurance solutions that meet the diverse needs of our customers. We are currently seeking a detail-oriented and customer-focused Claims Assistant to join our Medical Department.
Job Purpose
The Claims Assistant plays a vital role in the efficient operation of our medical insurance division. The incumbent is primarily responsible for processing medical claims, with a specific focus on controlling and managing member benefits through the rigorous vetting of inpatient and outpatient bills.
Beyond processing, this role is pivotal in provider network management. You will be responsible for recruiting new medical service providers and maintaining strong, professional relationships with existing ones. The role also involves active case management, maintaining the customer hotline, and handling real-time approval requests from hospitals and clinics to ensure a seamless experience for our clients.
Key Roles and Responsibilities
The Claims Assistant will execute duties across three main functional areas: Claims Processing, Provider Management, and Customer Service.
1. Claims Processing & Financial Control
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Verification: Verify and capture both outpatient and inpatient claims strictly following the company’s claims manual and policy guidelines.
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Assessment: Assess medical claims documents for authenticity, clinical appropriateness, and pricing correctness before processing payments within set Service Level Agreements (SLAs).
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Reconciliation: Conduct regular medical claims reconciliations with service providers. This is a critical control function intended to reduce company liability and ensure financial accuracy.
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Payment Requisition: Raise accurate payment requisitions within set standards to ensure providers are paid on time.
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Archiving: Ensure all physical and digital claims documents are archived appropriately for audit and future reference.
2. Provider Management & Recruitment
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Network Expansion: Identify gaps in our network and actively recruit new service providers (hospitals, clinics, pharmacies) to ensure our clients have access to care wherever they are.
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Relationship Management: Maintain good working relationships with service providers to ensure a smooth customer experience.
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Approvals: Assess and respond to pre-authorization and approval requests from service providers within set timelines, ensuring patients receive necessary care without delay.
3. Case Management & Customer Service
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Hospital Visits: Make physical visits to admitted patients (inpatient visits) to assess service satisfaction, check on patient prognosis, and advise on cost-saving interventions where necessary.
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Query Resolution: Promptly and efficiently attend to customer queries and complaints regarding their medical covers or claims status.
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Client Advisory: Register and process all reported medical claims and advise clients on the specific supporting documents required to fast-track their settlements.
Knowledge, Experience, and Qualifications
To be considered for this role, candidates must meet the following strict academic and professional criteria:
Academic & Professional Background:
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Education: A Bachelor’s Degree in a health-related field (e.g., Nursing, Clinical Medicine, Pharmacy, Healthcare Management) is mandatory.
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Professional Certification: A professional qualification in Insurance, specifically a Certificate of Proficiency (COP) in Insurance, is required.
Experience:
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2 to 4 years of relevant work experience.
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Added Advantage: Specific experience in medical claims processing within an insurance company or a medical administration firm will be considered a distinct advantage.
Essential Competencies
Britam values specific behavioral indicators in its emerging leaders:
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Learning and Researching: Rapidly learns new tasks and medical codes; gathers comprehensive information to support decision-making.
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Working with People: Shows empathy to patients; contributes to team spirit; consults others and shares expertise proactively.
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Adhering to Principles: Upholds high ethical standards; demonstrates integrity when handling sensitive medical data and financial transactions.
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Applying Expertise: Uses medical knowledge to vet claims effectively; develops job knowledge through valid continuous professional development (CPD).
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Delivering Results: Focuses on customer satisfaction; works in a systematic way to clear claims backlogs; consistently achieves project goals.
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Writing and Reporting: Writes clear and concise reports on patient visits and provider reconciliations; structures information logically.
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Analysing: Breaks down complex medical bills into component parts to identify errors or fraud; probes for further information when claims are unclear.
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Coping with Pressure: Maintains a positive outlook while working in a high-pressure environment; keeps emotions under control during difficult situations with denied claims.
Working Relationships
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Internal: You will be accountable to the Medical Manager and will work closely with the Finance and Underwriting departments.
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External: You will interact daily with Britam Customers, Hospitals, Doctors, and other Insurance sector players.
How to Apply
Closing Date: 01 December 2025
If you have a background in health and a passion for the insurance industry, we want to hear from you.
To submit your application, please follow the link provided below.
Britam is an equal opportunity employer. Only shortlisted candidates will be contacted.
