Summary
Date Posted: Friday, June 16 2023, Base Salary: Not Disclosed

JOB DETAILS:
Job Description
• To control and manage medical benefit utilization through preauthorization and case management activities and ensure quality, appropriate cost effective care and good customer service

Key Tasks And Responsibilities
• Pre-authorize scheduled and nonscheduled admissions within the set guidelines.
• Negotiate/discuss professional fees as appropriate for each admission.
• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
• Visit all admitted clients within Nairobi region and its environs
• Liaise with Doctors on the day to day management of patients and obtain medical reports/ expected length of stay where indicated.
• Ensure smooth discharge process and co-ordinate any necessary post- hospitalization/ step down facility care.
• Revise reserves after discharge of member.
• Collect feedback from admitted clients on quality and scope of service by the service provider.
• Assist in carrying out verification and medical audit of claims/invoices before settlement.
• Develop and maintain monthly database on admissions, large claims and extended length of stay.
• Respond to queries from clients, intermediaries and service providers.
• Liaise with other medical underwriter for purposes of market surveys and development of new controls, standards and products.
• Any other duty assigned by management.

Skills And Competencies
• Excellent communication and negotiation skills.
• Excellent public relations and interpersonal relationship skills.
• Extensive networking with SP and other medical insurers.
• Excellent analytical and monitoring skills
• Good IT skills in database management and office systems.
• Good decision making in benefit utilization management.
• High levels of integrity and honesty

qualifications, knowledge & experience
• Diploma or Degree in Nursing
• Diploma in Insurance/ COP
• Degree in Health systems Management/ Business management
• 3 years’ experience in clinical setting +2 years in insurance set up

Work Hours: 8

Experience in Months: 36

Level of Education: Bachelor Degree

Job application procedure
• Interested and qualified? Click here to apply

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