Britam Medical Care Associate - Jobs in Kenya

Britam Medical Care Associate - Jobs in Kenya

Medical Care Associate - Mombasa
Job Purpose:

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.
  • Delegated Authority: As per the approved
  • Delegated Authority Matrix
  • Prepare periodic reports for management on medical claims
  • Ensure claims are processed within the stipulated time.

    Knowledge,Experience and Qualifications
  • 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
    Emerging Leaders Competency Descriptions.
  • Presenting and Communicating Information - Speaks fluently; expresses opinions,
    information and key points of an argument clearly;
  • Presents effectively;
  • Responds quickly to others ‘reactions and feedback during conversations;
  • Projects credibility.
  • Working with People - Shows respect for the views and contributions of team members;
  • Shows empathy; listens, supports and cares for others;
  • Consults others and pro-actively shares information and expertise with them;
  • Builds team spirit and reconciles conflict; adapts to the team and fits in well.
  • Adhering to Principles and Values - Upholds and encourages ethical behavior and departmental values;
  • Demonstrates integrity; encourages individual
    responsibility towards the community and the environment;
  • Models the organizational values during every day interactions.
  • Analyzing - Analyses numerical data and all other sources of information, breaking
    them into component parts, patterns and relationships;
  • Probes for further information or greater understanding of a problem;
  • Makes rational judgments from the available information and analysis; demonstrates an understanding of how one issue may be part of a much larger system / process / problem.
  • Planning and Organizing - Adheres to and monitors clearly defined
  • Plans activities and projects well in advance and takes account of possible changing circumstances;
  • Identifies and organizes resources needed
    accomplish tasks;
  • Manages time effectively;
  • Monitors performance against deadlines and milestones.
  • Delivering Results and Meeting Customer
    Expectations - Focuses on customer
    needs and satisfaction;
  • Sets and models high standards for quality and
  • Monitors and maintains quality and productivity;
  • Works in a systematic methodical and orderly way; consistently achieves projects goals.
  • Deciding and Initiating Action - Takes responsibility for own, as well as subordinates’ actions and projects;
  • Takes initiative and works under own direction;
  • Initiates and generates activity; introduces improvements into work processes; handles problems with minimal guidance.
  • Leading and Supervising - Provides subordinates with a clear direction;
  • Motivates and empowers others;
  • Provides subordinates with the relevant coaching;
  • Creates a positive climate that fosters learning and development;
  • Identifies high potential talent; sets and articulates the departmental vision and values through own personal behavior;
  • Sets appropriate standards of behavior.
  • Formulating Strategies and Concepts - Works strategically to realize personal
  • Understands and effectively communicates the departmental strategy;
  • Translates the departmental strategy and vision into operational responsibilities;
  • Takes into consideration departmental strategy during all tasks;
  • Takes account of a wide range of issues across, and related to current role.
  • Applying Expertise and Technology - Applies specialist and detailed technical expertise;
  • Uses technology to achieve work objectives;
  • Develops job knowledge and expertise (theoretical and practical) through continual professional development;
  • Demonstrates an understanding of different organizational departments and functions.
  • Following Instructions and Procedures - Challenges authority only when appropriate;
  • Follows procedures and policies;
    keeps to schedules;
  • Arrives punctually for work and meetings;
  • Demonstrates a commitment to the organization; complies with legal obligations and safety requirements of the role.
  • Adapting and Responding to change - Adapts to changing circumstances;
  • Tolerates ambiguity;
  • Accepts new ideas and change initiatives;
  • Adapts interpersonal style to suit different people or situations;
  • Shows an interest in new experiences.

    How to Apply
  • Interested and qualified candidates should apply online by 14th July 2019
  • For more information and job application details, see; Britam Medical Care Associate - Jobs in Kenya

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