Britam EMC Medical Claims Assistant Jobs in Kenya

Britam EMC Medical Claims Assistant Jobs in Kenya

Job Purpose:

Controlling and Managing policies through case management to ensure quality and cost effective care., client service, processing and payment of EMC claims.

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.

  • Review documents and pertinent requirements regarding claims from providers and clients.

  • Ensure that the claim made by the claimant is complete in form and complies with the documentary requirements of an insurance claim.

  • Management of relationships with clients, intermediaries and service providers.

  • Verification and audit of outpatient and inpatient claims to ensure compliance and mitigate

  • Advice claimants regarding basic matters about their insurance coverage in relation to the insurance claim.

  • Respond to both internal and external claims inquiries concerning claims process, service providers, and the filing/completion of proper forms.

  • Record all claims transactions.

  • Prepare claims registers for claims meetings and update the various claims reports.

  • Track and follow up on receipt of necessary documents.

  • Delegated Authority: As per the approved Delegated Authority Matrix.

    Knowledge, experience and qualifications required:

  • Professional Nursing qualification KRCHN licensed by Nursing council of Kenya.

  • At least one year experience in case management and claims processing.

    How to Apply

    For more information and job application details, see; Britam EMC Medical Claims Assistant Jobs in Kenya

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