Michael Ochara

At Medical Administrator Kenya Ltd, I review and adjudicate 25–40 medical claims daily, balancing clinical appropriateness, medical necessity, benefit rules, and cost containment.

I conduct pre-authorization assessments, resolve member and provider inquiries, review claims exposure, and support audits, trend analysis, and fraud, waste, and abuse risk identification. I work closely with teams to interpret evolving SHA and insurance policies while maintaining 24–48-hour turnaround times for standard claims.

Before moving into medical claims, I delivered high-volume outpatient care at Mkunga Maternity & Nursing Home and Saika Nursing Home. As a Clinical Officer-in-Charge and Quality Improvement Focal Person, I supported clinical operations, patient safety, documentation standards, referrals, and preventive health education.

I'm committed to strengthening healthcare financing and quality patient outcomes through clinical judgment, accurate documentation, utilization management, and continuous learning in medical coding, data analytics, and digital health.