Job Description:
Claims Payment Integrity Consultant
Nairobi, Kenya
Full time
Permanent
Advert closes Friday 3rd October 2025
We make health happen
At Bupa, we're here to help people live longer, healthier, happier lives and make a better world. As a Claims Payment Integrity Consultant, you'll play a vital role in protecting the integrity of our claims process. You'll help ensure that payments are accurate, legitimate, and made to the right people-supporting our mission to deliver trusted, high-quality healthcare.
This role sits within Bupa Global, where we serve customers across the world. You'll be part of a team that's passionate about doing the right thing, reducing fraud, and making sure our members get the care they need. It's a role that combines attention to detail, investigative thinking, and a strong sense of purpose.
How you'll help us make health happen
Review and approve new bank account details before claims are paid
Validate provider information for new and existing providers not yet stored in our systems
Add verified providers to our SWAN system with complete and accurate contact details
Investigate out-of-network providers flagged by claims rules
Refer suspicious providers to our Counter Fraud Team and reject unverifiable claims
Respond to customer queries and additional information related to claims
Identify and escalate potential fraudulent behaviour by members or providers
Support cost containment by following claims guidelines and rules
Collaborate with internal stakeholders, including Claims Fraud Validation Officers
Maintain accurate customer records and ensure updates are made promptly
Comply with regulatory standards including Financial Regulatory Authority (FRA), Insurance Regulatory Authority (IRA) and Treating Customers Fairly
Meet service level agreements and quality standards
Support new team members and contribute to continuous improvement
Be a role model for Bupa's values and behaviours
Key skills/qualifications required for this role
Previous experience in medical claims is essential
Medical background would be beneficial
Strong written and spoken English; multilingual skills are a plus
Excellent problem-solving and prioritisation skills
High attention to detail and strong numerical ability
Comfortable working independently and as part of a team
Understanding of regulatory environments and customer fairness principles
Ethical, honest, and resilient with a commitment to doing what's right
Confident in managing risk and contributing to a compliant, trustworthy claims process
Time Type:
Full timeJob Area:
Locations:
Kenya - Nairobi
Bupa’s purpose is helping people live longer, healthier, happier lives and making a better world. We do this by providing a broad range of healthcare services, support and advice to people throughout their lives. People are at the heart of everything we do. Together, we make health happen.
Every company needs an ethos, and we're no different. Through good days and challeging times, we always work with our values in mind. These are: Brave - Make new possibilities happen. Caring - Act with empathy and respect. Responsible - Own your decisions and actions.
We don't have shareholders at Bupa, which means we're free to invest our profits where they matter: our patients, our facilities, our research, and you.
As a healthcare provider, we have a duty to do the right thing. By our customers, our people and our partners. The Bupa Code holds us to this duty. It's our promise to protect, care for, and build trust with everyone who relies on us.
Here you’ll be welcomed. We champion diversity and we understand the importance of our people representing the communities and customers we serve.
You’ll find an inclusive environment where you can be yourself and where everyone is driven by the same purpose – helping people live longer, healthier, happier lives and making a better world.Free
to be you.
Back in September 2018, we made a pledge. That we'd do whatever we could to make Bupa a diverse, kind and inclusive place to work.
Everyone deserves a positive working environment. Everyone deserves to have their voice heard. Everyone deserves freedom from bullying, harassment and discrimination.