Senior Medical Claims Analyst at Medical Administrators Kenya Limited (MAKL) (2025-01 – Present)
- Lead end-to-end medical claims processing for inpatient and outpatient services across a diverse network of healthcare facilities.
- Coordinate pre-authorization reviews and ensure adherence to approved clinical guidelines for complex and high-cost medical cases.
- Drive fraud detection, utilization review, and cost-containment initiatives to ensure policy compliance and financial efficiency.
- Facilitate effective communication and coordination between healthcare providers, hospitals, insurers, and internal stakeholders.
- Manage medical evacuation cases while ensuring compliance with service level agreements and turnaround time requirements.
- Review and validate treatment plans, clinical documentation, and hospital invoices to confirm medical necessity and appropriate levels of care.
Medical Claims Analyst at Medical Administrators Kenya Limited (MAKL) (2023-01 – 2024-12)
- Executed pre-authorization approvals for hospital patient reviews across diverse medical specialties.
- Conducted comprehensive physical audits at healthcare facilities to ensure compliance and quality standards.
- Vetted and processed patient billing documentation from multiple hospitals for accuracy.
- Identified and investigated fraudulent claims and billing irregularities in healthcare facilities.
- Approved final hospital claims following thorough clinical and financial review.
Registered Clinical Officer at Lumino Nursing Home (2022-10 – 2022-12)
- Delivered comprehensive primary healthcare services including diagnostics, treatment, and patient management.
- Managed emergency presentations and coordinated appropriate specialist referrals.
- Implemented evidence-based treatment protocols in line with facility guidelines.
- Conducted health education sessions and preventive care counseling for diverse patient populations.
- Ensured strict adherence to infection control standards and clinical safety procedures.
- Maintained accurate medical documentation and patient records management systems.
Registered Clinical Officer at Maxicare Sunrise Hospital (2021-04 – 2022-10)
- Performed comprehensive patient assessments, diagnoses, and evidence-based treatment interventions.
- Coordinated emergency care services and facilitated timely referrals for specialized treatment.
- Developed and implemented weekly clinical plans, schedules, and performance reports.
- Championed patient-centered care through effective counseling and health education initiatives.
- Participated actively in clinical training programs and continuous professional development activities.
- Ensured compliance with hospital protocols and infection control standards.
Registered Clinical Officer at Oasis Doctors Plaza (2020-11 – 2021-04)
- Conducted comprehensive patient consultations, examinations, and treatment planning.
- Managed acute and emergency cases requiring immediate medical intervention.
- Delivered preventive and primary healthcare education to patients and communities.
- Maintained patient confidentiality and managed sensitive health information appropriately.
- Participated in community health outreach programs and awareness campaigns.
Registered Clinical Officer at Africa Inkuka Hospital, Ugunja Branch (2020-06 – 2020-10)
- Provided emergency medical care and immediate intervention for acute presentations.
- Performed patient diagnoses and prescribed appropriate evidence-based treatment regimens.
- Conducted normal deliveries and minor surgical procedures within scope of practice.
- Managed inpatient care and monitoring for severe cases requiring admission.
- Facilitated referrals for patients requiring higher-level specialized care.
Internship Clinical Officer at Karatina Subcounty Hospital (2019-01 – 2020-12)
- Completed comprehensive clinical internship rotation across multiple hospital departments.
- Conducted thorough patient histories, physical examinations, and clinical assessments.
- Diagnosed and managed common health conditions under supervision.
- Performed normal deliveries and minor surgical procedures following established guidelines.
- Attended Continuing Medical Education (CME) sessions for professional development.
Pre-Internship Clinical Officer at Cheldeb Medical Clinic (2018-08 – 2018-11)
- Managed emergency cases and provided timely primary healthcare services.
- Performed accurate clinical diagnoses and treatment recommendations.
- Facilitated smooth patient referral processes to minimize adverse outcomes.
- Prepared periodic clinical reports for facility management.
