Dancan Karakach
@dancankarakach1
Experienced Senior Medical Claims Analyst with a focus on fraud prevention.
What I'm looking for
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
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.
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.
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.
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.
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
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.
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
Availability
Location
Authorized to work in
Job categories
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