Case Study

Building the NHIF Invoicing SOP That Recovered Over 10M KES in Stuck Claims

City Eye Hospital Limited
City Eye Hospital Limited

Six months after they were signed, City Eye Hospital's NHIF invoices remained unsubmitted because no one in the finance team knew the correct process. As a new accountant, I built a full summary of every pending invoice, took the issue to the Finance Manager and got approval to fix it. I contacted NHIF directly to learn the submission process, then built the SOP that made it repeatable. The hospital went on to claim over 10M KES in bad debts that had been sitting unclaimed.

Context

City Eye Hospital relied on NHIF and other insurers to settle a significant share of patient invoices, but no documented process existed for submitting NHIF claims once they were signed off. I inherited this gap early in my time as an accountant there.

The Challenge

Invoices that sit unsubmitted for six months or more risk becoming unrecoverable, and without a clear owner or process, the backlog kept growing rather than clearing. Fixing it required both permission to act and a process that had never existed before.

Strategic Approach

How the Work Got Done

1

Diagnosis

I built a complete summary of every pending NHIF invoice, giving management a clear picture of the scale of the problem for the first time.

2

Authorisation

I approached the Finance Manager directly with the summary and secured the go-ahead to own the fix.

3

Resolution and documentation

I contacted NHIF to confirm the correct submission process, then worked with the Finance Manager to develop a formal SOP for NHIF invoicing, extending the same discipline to other insurers.

Quantifiable Outcomes

The Numbers Behind the Work

10M+ KESBad Debts Recovered
6+Months Stuck Pre-SOP

Recovered over 10M KES in bad debts that had been stuck for 6+ months.

Qualitative Achievements

Beyond the Numbers

Converted a fully undocumented process into a repeatable SOP still in use for NHIF and other insurers.
Cleared a backlog that had accumulated with no prior submissions in over six months.
Turned an invisible, unowned problem into a resolved process with a clear owner.
Earned the Finance Manager's trust to take initiative on a process no one else had tackled.
Improved invoicing discipline for insurers beyond NHIF as a direct result of the SOP.
The biggest recoverable losses are often sitting in processes nobody has documented yet, not in numbers nobody has found yet.

What started as a summary of stuck invoices became a standard operating procedure that outlived my time at City Eye Hospital. It remains one of the clearest examples of how documentation, not just diligence, protects revenue.

Skills In Action

What This Engagement Drew On

Technical Proficiencies
Microsoft Excel
Sage 50
QuickBooks Online
Competencies Displayed
Process design
Revenue recovery
Stakeholder authorisation management
Insurer compliance