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Dancan Karakach

@dancankarakach1

Experienced Senior Medical Claims Analyst with a focus on fraud prevention.

Kenya
Message

What I'm looking for

I seek a dynamic role that fosters professional growth and leverages my expertise in claims analysis and fraud prevention.

I am a dedicated Senior Medical Claims Analyst with a strong background in insurance and risk management. Currently, I work at Cigna International Health Benefit, where I leverage my expertise to enhance claims processing and fraud detection. My role involves reviewing claims, implementing fraud prevention methods, and providing expert guidance to partners on complex claims issues.

Previously, I served as a Reinsurance Officer at Pioneer Assurance, where I prepared reinsurance treaty payments and developed service level agreements with partners. My experience spans various roles within the insurance sector, including underwriting and claims assistance, which has equipped me with a comprehensive understanding of the industry.

With a Bachelor of Science in Actuarial Science and additional training in data analytics, I am committed to continuous professional growth and contributing to organizational success through innovative solutions and effective communication.

Experience

Work history, roles, and key accomplishments

CB
Current

Senior Medical Claims Analyst

Cigna International Health Benefit

Jan 2022 - Present (3 years 5 months)

Reviewed sample claims to identify areas for improvement and detected potential fraud attempts. Created and implemented methods for blacklisting persons and providers involved in insurance claims fraud, serving as a primary point of contact for partners regarding claims-related inquiries.

PA

Reinsurance Officer

Pioneer Assurance

Jul 2021 - Dec 2022 (1 year 5 months)

Prepared reinsurance treaty payments, renewals, and claims reports for management. Collected recoveries from other reinsurance companies and submitted treaty and facultative claims for recovery. Developed and enforced SLAs with reinsurance partners and negotiated treaties.

PA

Underwriting Assistant

Pioneer Assurance

Jan 2020 - Jun 2021 (1 year 5 months)

Ensured accurate reinsurance underwriting and proper risk allocation to treaties and other RI arrangements. Advised members on medical tests, communicated underwriting decisions, and conducted financial underwriting on all risks. Assessed all proposals and accompanying schedules for compliance.

PA

Claims Assistant

Pioneer Assurance

Jun 2019 - Dec 2019 (6 months)

Entered claims into the system for analysis and performed claims documentation vetting and analysis. Processed and paid claims, and assisted in customer service for walk-in clients.

PA

Branch Administrator

Pioneer Assurance

Jan 2019 - May 2019 (4 months)

Performed data entry for new business acquired and attended to walk-in clients’ inquiries and complaints. Managed financial receipting for premiums paid in cash and prepared/submitted financial reports for the branch. Supervised salespeople and planned meeting calendars.

Education

Degrees, certifications, and relevant coursework

JU

Jaramogi Oginga Odinga University

Bachelor of Science, Actuarial Science with Information Technology

Pursued a Bachelor of Science in Actuarial Science with Information Technology. The curriculum covered core principles of actuarial science combined with practical applications of information technology.

ZC

Zachtech Training College

Certificate, Data Analytics

Grade: Distinction

Completed a specialized program in Data Analytics, gaining proficiency in tools such as Excel and SPSS. Achieved a distinction upon graduation, demonstrating strong analytical skills.

Tech stack

Software and tools used professionally

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Dancan Karakach - Senior Medical Claims Analyst - Cigna International Health Benefit | Himalayas