Medical Care Associate At Britam

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Medical Care Associate At Britam 1 Position
Emploi Recruitment

Nairobi, Kenya

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Full-time
Insurance
Posted 1 month ago

Job Description

Job Purpose

The role holder will be responsible for controls and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care within Mombasa region.

Key responsibilities

  1. Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration)
  2. Interact with clients and service providers to ensure that the care is given within policy guidelines
  3. Review medical reports and claims for compliance with set guidelines
  4. Liaise with underwriters on scope of cover for the various schemes
  5. Ensure that medical scheme members are attended to round the clock with support from 24 hour call centre.
  6. Poly-Pharmacy - discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.
  7. Generic substitution - Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.
  8. Prepare periodic reports for management on medical claims
  9. Ensure claims are processed within the stipulated time
  10. Delegated Authority:  As per the approved Delegated Authority Matrix.
 

 

Knowledge, experience and qualifications required
 
  1. Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
  2. Moderate understanding of insurance concepts
  3. Professional qualification in FLMI, ACII and IIK.
  4. 5-8 years’ experience in case management two of which should be in a supervisory position
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Emploi Recruitment
Emploi Recruitment

Nairobi, Kenya

51 - 299 people

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