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Aggrey Shiundu

Aggrey Shiundu

Senior Clinical Pharmaceutical Practitioner

Followers of Aggrey Shiundu887 followers
location of Aggrey ShiunduNairobi County, Kenya

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  • Timeline

  • About me

    Medical Claims Expert |Health Systems Strengthening|Clinical Pharmacy| Educator| Health Insurance.| TQM(Total Quality Management)

  • Education

    • Kenya Medical Training College

      2007 - 2010
      PharmD Pharmacy CREDIT

      Activities and Societies: Kenya Pharmaceutical Association. Kenya Diabetes Association. I have vast experience in stock inventory management,clinical pharmacy,community pharmacy and pharmaceutical law and ethics. I believe in getting things done.

    • College of Insurance

      2022 - 2025
      AIIK Insurance

      The Diploma in insurance Course is designed to equip the trainee with knowledge, skills andattitudes that will enable him/her to manage insurance functions effectively. The technical andspecialization units in the programme are designed to make the trainee acquire a wide range ofskills in insurance practice.

    • Kenya Methodist University

      2014 - 2017
      Bachelor of Science (BSc)in Health Systems Management Health systems strengthening, strategic planning, total quality management and operational research Second Class Hons Upper Division

      Activities and Societies: Team Leader HEALTH Systems MANAGEMENT Class of 2014 Management of health systems, physical infrastructure. information technology in health and budgeting

  • Experience

    • Avenue Group

      Feb 2011 - Mar 2017
      Senior Clinical Pharmaceutical Practitioner

      • Facilitation of drug procurement in liaison with the Hospital Therapautics Committee.• Proper drug storage and dispensing as per Pharmacy and Poisons Act Cap 244-245 Laws of Kenya.• Computing and recording prescription charges, for financial information purposes.• Patient counseling on drug administration and use of devices thus promotion of recovery• Maintaining and updating personal drug knowledge data base to ensure accurate provision of pharmaceutical care of general disease states• Maintaining proper accounting records for pharmaceutical stock (monitoring of short expiry drugs and slow moving stock)• Provide support in counter checking doctor prescribing practices• Extemporaneous preparations based on a consultant prescription• Ensuring good customer relations and treatment coordination• Ensuring use of appropriate formulations, documentation and reporting of adverse drug interactions.• Ensuring proper storage and supply of drugs to the inpatients Show less

    • KENYA MEDICAL TRAINING COLLEGE

      Sept 2014 - Mar 2017
      Guest Lecturer

      Actively involved in:Lecturer HSM1(Health systems management 1),HSM II(health systems management 2 ) and Drug Supply Management to Diploma in Pharmacy students.Guest Lecturer for Inorganic Chemistry 1 and Inorganic chemistry 2

    • Britam

      Mar 2017 - now

      1. Oversee the claims process flows to ensure efficiency in processing of claims as per the company medical claims procedure manuals2. Verification and audit of outpatient and inpatient claims as per the claims manual and customer service charter manual to ensure compliance and mitigate risk3. Oversee processing and settlement of medical claims 4. Hold regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs5. Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers6. Supervise; train and mentor medical claims staff to achieve a high level of motivation and productivity by the team.7. Prepare regular claims reports to clients, management and advice medical underwriting section on relevant claims findings for medical risk review8. Relationship management with stakeholders who have special interest in the business. Show less CORE OBJECTIVES AND RESPONSIBILITIES INCLUDE:1. Auditing and Verification of outpatient, inpatient and reimbursement claims as per clinical guidelines and within the recommended guided tariffs.2. Price guided tariffs- building of provider price-lists especially for bigger providers on average pharmaceutical expenditure.3. Trend Analytics – Analysis of prescription patterns for providers and prescription drug use by members based on system-generated reports especially for chronic medication.4. Involvement and participation in formulation of the CPT codes for medicines to track expenditure and provide trend analysis.5. Training of medical claims team on current treatment protocols on need basis and best practice.6. Auditing independent pharmacies and pharmacies within the various hospitals.7. Providing of novel strategies on reduction of the company’s pharmaceutical expenditure.8. Developing and maintaining networks within pharmaceutical sector, keeping updates on current practices, participates in professional societies9. Outsourcing of non-pharmaceutical equipment with an aim to reduce costs on hospital mark ups.10. Good clinical acumen and keeps up to date with latest trends as provided by ministry of health and any other global bodies.11. Ensuring regulatory control and drug management on all prescriptions ensuring advice on adverse drug reactions are suspected, or where potential on drug interactions existing and ensuring dosage and medicines are accurately prescribed.12. Service provider management-Ensuring all service providers meet the set service level agreements.13. Processing of medical claims with key focus on pricing of pharmaceuticals, diagnosis matches with the treatment, building price guided tariffs and ensuring prescriptions are vetted for forger & inappropriate billing.14. Promoting use of generic drugs especially in chronic disease management in order to manage cost and maintain quality of service. Show less

      • Assistant Manager Medical Claims

        Feb 2023 - now

      • Corporate Health Claims Team Leader

        Mar 2021 - Apr 2023

      • Medical Claims Adjudicator

        Mar 2017 - Mar 2021

  • Licenses & Certifications

  • Honors & Awards

    • Awarded to Aggrey Shiundu
      Outstanding performance in Customer Experience 2019 GI Medical Claims Britam Nov 2019 This award represents the person you reach out to for quick resolution, who is always eager to assist and focused on service delivery.
    • Awarded to Aggrey Shiundu
      Learning Champion Medical Britam Jan 2019 Creation of learning objectives associated with the business and continuous medical education