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Case Management Officer
2 months ago
ABOUT THE COMPANY
We are a diversified financial group, listed on the Nairobi Securities Exchange, with interests across the Eastern Africa region. We offer a wide range of financial products and services in insurance, asset management, banking and property, with offices in Kenya, Uganda, Rwanda, South Sudan; and presence in Mozambique, Malawi and Tanzania, following the acquisition of Real Insurance in 2014. The product range includes: life, health and general insurance, pensions, unit trusts, investment planning, wealth management, off-shore investments, retirement planning, discretionary portfolio management, Property development and private Equity.Our Mission is to provide outstanding financial services to our customers.Our Vision is to be the most trusted financial service partner.We aim to provide our clients, with an unmatched offering, ensuring first class solutions that help secure the future.
JOB SUMMARY
Knowledge, experience and qualifications required Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.Progress in Professional qualification in Insurance (ACII, FLMI or IIK).3-6 years' experience in case management.Proven experience in managing and nurturing client relationships.Track record of achieving client satisfaction and retention targets.
RESPONSIBILITIES
Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).Interact with clients and service providers to ensure that the care is given within policy guidelines.Review medical reports and claims for compliance with set guidelines.Liaise with underwriters on scope of cover for the various schemes.Ensure that medical scheme members are attended to round the clock with support from 24 hour call centre.Poly-Pharmacy – discourage poly-pharmacy by diligent challenging of prescriptions and suggesting better alternatives.Generic substitution – Encourage use of generics where indicated as a method of reducing the organizations pharmaceutical expenditure.Prepare periodic reports for management on medical claims.Ensure claims are processed within the stipulated time.Delegated Authority: As per the approved Delegated Authority Matrix.
REQUIRED SKILLS
Reporting, Accounting, Auditing of accounts, Bookkeeping, Credit handling, Financial reporting, Handling claims, CPA certification, Accounting IT-systems (use of), Payment collection
REQUIRED EDUCATION
Bachelor's degree
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