Assistant Claims Officer

6 days ago

Nairobi, Nairobi Area, Kenya Britam Full time 1,200,000 - 2,400,000 per year

Job Purpose
Control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care.

Key Responsibilities

  • Ensure all received claims are vetted and released to finance on time (Credit and reimbursement claims).
  • Set the appropriate parameters for each admission and claims for IP and OP (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.
  • 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.

Key Performance Measures
As described in your Personal Score Card.

  • Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
  • Moderate understanding of insurance concepts.
  • Professional qualification in FLMI, ACII and IIK.
  • 5-8 years' experience in case management two of which should be in a supervisory position.

Primary Location
Kenya-Nairobi-Nairobi

Organization
Britam

Job Type
Contractual

Shift
Day Job

Contract Type
Full-time

Job Posting

Unposting Date

Number of Openings
1

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