Britam Care Management Assistant Jobs in Kenya

Britam Care Management Assistant Jobs in Kenya

Job Purpose:

Reporting to the Team Leader Corporate Care Management, The role holder will be responsible for control and managing of the policy cycle through pre-authorization and case management, to ensure quality and cost effective care.

Key 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.

    Knowledge, experience and qualifications required

  • 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.

    Technical/ Functional competencies:

  • Knowledge of insurance regulatory requirements.

  • Knowledge of insurance products.

  • Sales and marketing management skills.

    How to Apply

    For more information and job application details, see; Britam Care Management Assistant Jobs in Kenya

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