Claims Officer – Medical job at CIC Insurance Group PLC
Posted by: great-volunteer
Posted date: 2026-Nov-11
Location: Kampala
Claims Officer – Medical 2026-11-11T13:46:21+00:00 CIC Insurance Group PLC https://cdn.ugashare.com/jsjobsdata/data/employer/comp_3261/logo/CIC%20Insurance%20Group%20PLC.png https://www.ugashare.com/jobs/ FULL_TIME Kampala Kampala 00256 Uganda Insurance Healthcare, Business Operations, Admin & Office, Professional Services 2026-11-20T17:00:00+00:00 8 About Us CIC Insurance Group is a leading cooperative-based insurance and financial services organisation with more than five decades of experience helping individuals, families, and organizations achieve financial security. We have grown into a dynamic Group offering life, general, micro insurance, asset management, and investment solutions, with operations in Kenya, Uganda, South Sudan, and Malawi, and are listed on the Nairobi Securities Exchange.Buy Maps Our tagline, “We Keep Our Word,†reflects our unwavering commitment to integrity, transparency, and delivering on our promises to our clients, partners, and communities. CIC Group is passionate about innovation, digital transformation, and inclusive insurance solutions that meet the evolving needs of cooperatives, SMEs, corporates, and individuals. You will be part of a team that is shaping the future of financial protection across Africa. About the Role Reporting to the Head of Medical, the role is responsible for assessment, processing and settlement of medical insurance claims by ensuring fairness, accuracy and compliance with company policies and industry regulations. It also ensures timely claims management, cost control and provides technical guidance to the medical team safeguarding the company against fraudulent or unjustified claims. Key Responsibilities Claims Processing & Assessment - 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.
Claims Review & Verification - Liaise with medical service providers to confirm treatments, diagnoses, and procedures.
- Evaluate and authorize complex and high – value medical claims within delegated authority.
- Ensure claims decisions are based on policy terms, medical evidence and underwriting guidelines.
- 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.
Customer Service & Stakeholder Management - 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.
Compliance & Reporting - 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.
- Provide feedback to underwriting and product teams on emerging risks and medical cost drivers.
Medical &Provider Liaison - Coordinate with hospitals, clinics and medical practitioners for claim verifications.
- Negotiate costs and settlements with healthcare providers.
- Liaise with reinsurers for facultative claims and recoveries.
- Any other duties that may be assigned from time to time.
Who We’re Looking For Qualifications - Bachelor’s Degree in relevant field
- Uganda Registered Nursing (URN
Key competencies - Organized, detail-oriented, and able to work under tight timelines.
- Committed to professional growth and continuous learning.
- Good collaborator with good communication skills.
Why Join us? Join CIC Insurance Group as a Claims Officer – Medical and be part of a team committed to delivering fair, efficient and customer-focused medical claims solutions. You will gain exposure to medical claims assessment, clinical reviews, healthcare provider engagement, fraud detection and claims cost management while contributing to quality service delivery and effective risk management. Working alongside experienced professionals, you will have the opportunity to apply your medical expertise, strengthen your technical capabilities and support the delivery of reliable and sustainable medical insurance solutions. At CIC, you will be part of a collaborative environment that values integrity, innovation and continuous professional growth. - 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.
- Liaise with medical service providers to confirm treatments, diagnoses, and procedures.
- Evaluate and authorize complex and high – value medical claims within delegated authority.
- Ensure claims decisions are based on policy terms, medical evidence and underwriting guidelines.
- 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.
- Provide feedback to underwriting and product teams on emerging risks and medical cost drivers.
- Coordinate with hospitals, clinics and medical practitioners for claim verifications.
- Negotiate costs and settlements with healthcare providers.
- Liaise with reinsurers for facultative claims and recoveries.
- Any other duties that may be assigned from time to time.
- Organized
- detail-oriented
- able to work under tight timelines
- Committed to professional growth
- continuous learning
- Good collaborator
- good communication skills
- Bachelor’s Degree in relevant field
- Uganda Registered Nursing (URN)
JOB-6af471add0a6a Vacancy title:
Claims Officer – Medical Jobs at:
CIC Insurance Group PLC Deadline of this Job:
Friday, November 20 2026 Duty Station:
Kampala | Kampala Summary
Date Posted: Wednesday, November 11 2026, Base Salary: Not Disclosed JOB DETAILS:
About Us CIC Insurance Group is a leading cooperative-based insurance and financial services organisation with more than five decades of experience helping individuals, families, and organizations achieve financial security. We have grown into a dynamic Group offering life, general, micro insurance, asset management, and investment solutions, with operations in Kenya, Uganda, South Sudan, and Malawi, and are listed on the Nairobi Securities Exchange.Buy Maps Our tagline, “We Keep Our Word,†reflects our unwavering commitment to integrity, transparency, and delivering on our promises to our clients, partners, and communities. CIC Group is passionate about innovation, digital transformation, and inclusive insurance solutions that meet the evolving needs of cooperatives, SMEs, corporates, and individuals. You will be part of a team that is shaping the future of financial protection across Africa. About the Role Reporting to the Head of Medical, the role is responsible for assessment, processing and settlement of medical insurance claims by ensuring fairness, accuracy and compliance with company policies and industry regulations. It also ensures timely claims management, cost control and provides technical guidance to the medical team safeguarding the company against fraudulent or unjustified claims. Key Responsibilities Claims Processing & Assessment - 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.
Claims Review & Verification - Liaise with medical service providers to confirm treatments, diagnoses, and procedures.
- Evaluate and authorize complex and high – value medical claims within delegated authority.
- Ensure claims decisions are based on policy terms, medical evidence and underwriting guidelines.
- 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.
Customer Service & Stakeholder Management - 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.
Compliance & Reporting - 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.
- Provide feedback to underwriting and product teams on emerging risks and medical cost drivers.
Medical &Provider Liaison - Coordinate with hospitals, clinics and medical practitioners for claim verifications.
- Negotiate costs and settlements with healthcare providers.
- Liaise with reinsurers for facultative claims and recoveries.
- Any other duties that may be assigned from time to time.
Who We’re Looking For Qualifications - Bachelor’s Degree in relevant field
- Uganda Registered Nursing (URN
Key competencies - Organized, detail-oriented, and able to work under tight timelines.
- Committed to professional growth and continuous learning.
- Good collaborator with good communication skills.
Why Join us? Join CIC Insurance Group as a Claims Officer – Medical and be part of a team committed to delivering fair, efficient and customer-focused medical claims solutions. You will gain exposure to medical claims assessment, clinical reviews, healthcare provider engagement, fraud detection and claims cost management while contributing to quality service delivery and effective risk management. Working alongside experienced professionals, you will have the opportunity to apply your medical expertise, strengthen your technical capabilities and support the delivery of reliable and sustainable medical insurance solutions. At CIC, you will be part of a collaborative environment that values integrity, innovation and continuous professional growth. Work Hours: 8 Experience in Months: 24 Level of Education: bachelor degree Job application procedure
If you have the aforementioned professional and academic qualifications and you are ready to execute the above mandate, strictly apply through: Application Link: clearly indicating the position being applied for. The application should reach us by close of business on 20th November 2026. Please note only short-listed candidates will be contacted. If you do not hear from us by 30th November 2026 consider your application unsuccessful.
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