Applications are invited from appropriately qualified candidates for the position of Assistant Care Manager in the Medical Department.
The position will be based in Meru.
Position Summary: The successful candidate will be responsible for supervision of the claims process, provider customer care management as well as coordination of care management to ensure the medical department achieves the desired goals and objectives in line with the organization’s strategy.
Key Deliverables:
- Supervision and Coordination of care management
- Guiding Claims staff, upon request on difficult non-routine claim/client/broker/provider queries
- Interact with clients, brokers and clinicians as needed, to resolve problems within policy.
- Check and confirm membership validity and benefits (from the scheme benefits file)
- Vet and confirm validity of the service given by the service provider in relation to the benefits covered, treatment given, adherence to provider panel rules and cost of treatment
- Coordinate and supervise obtaining of additional required information on claims from providers, brokers or clients by team leaders
- Liaising with our underwriting section on scope of cover for various schemes
- Advice management on any peculiarities noted in the claims from group providers
- Assist in conducting provider audits wherever necessary.
- Client presentations and member education on wise utilization & risk management
- Address customer satisfaction issues promptly in accordance with the corporate strategy
- Manage the 24-hour emergency helpline
- Ensure claims position for the team is up to date
- Preparations of Monthly and weekly Care Management report; reimbursement claim status reports as well as admission reports
- Handling non routine queries from Brokers, providers and clients, Medical service provider
Requirements:
Applicant should have:
- Degree in Medicine with at least 2 years of practice
- A registered nurse with 5 years of practice
- Basic understanding of the concepts of insurance; Good Numerical skills
How to Apply:
If you are up to the challenge & fit the required profile, please apply highlighting your qualification, experience and career aspirations match the requirement for this position.
Application should be sent latest 12th August 2022 clearly indicating the position you are applying for on the Subject to: ke-vacancies@mua.co.ke.
Only short-listed candidates will be contacted.