Medical Claims Officer

About Marie Stopes Tanzania (MST)

Marie Stopes Tanzania (MST), a Non-Governmental Organization, is a social enterprise and a leading provider of family planning, sexual and reproductive health care and allied services. MST is a partner of the Government of Tanzania and a member of the Marie Stopes International (MSI) Global Partnership, which operates in over 37 countries worldwide. MST’s mission is that all women and men in Tanzania will have “Children by Choice, Not Chance”.

Our organization is committed to safeguarding and promoting the welfare of children, young people and vulnerable adults and expects all staff and post holders to share this commitment.

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 claims 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.
• nafasi za kaziMaintain 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 Medicine is mandatory.
• Certificate Diploma or Degree in any field of insurance will be an added advantage.
• Minimum 2–5 years of experience in medical claims vetting or healthcare insurance in Tanzania.
• Registered with Medical council of Tanganyika.
• Strong understanding of the 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 portals and private insurer platforms.
• Knowledge of Tanzanian healthcare compliance and audit procedures.

Reporting to: Customer Care Manager

If you feel that you are able to meet the requirements and you are motivated enough to be part of the team, please send your applications including a cover letter detailing your suitability and why you are interested in this post to the address below.

Head of Human Resources and Administration
Marie Stopes Tanzania
11 Majuva Street – Mwenge
P. O. Box 7072, Dar Es Salaam.
Telephone: +255 22 2774991 / 4
VOIP +255 768 987 780
Closing date: All applications should reach the addressee before Friday June 13th, 2025. Only short-listed candidates will be contacted.