CIC Insurance Care Officer – Microinsurance Jobs in Kenya
About the Role
Reporting to the Assistant Manager Care Management, the role holder will ensure the efficient and effective management of insured members’ medical care by overseeing approvals, coordinating treatment processes and monitoring benefit utilization in line with organizational policy guidelines, while delivering high-quality customer support.
Key Responsibilities
Issue medical approvals for insured members seeking inpatient and outpatient services in accordance with policy terms.
Monitor inpatient admissions, treatment costs and average length of stay to ensure cost-effective care.
Provide pre-authorization guidance for scheduled procedures, including optical and dental services.
Conduct daily hospital visits to support insured members during hospitalization and ensure quality care delivery.
Respond promptly and professionally to stakeholder inquiries regarding medical care management cases.
Receive and respond to medical emergency calls through the 24-hour call center, ensuring compassionate, accurate and timely assistance to clients and healthcare providers.
Negotiate discounts with healthcare providers, including doctors and hospitals, for specific procedures or high-cost cases as required.
Coordinate with clients and medical providers to leverage SHA/SHIF packages.
Facilitate medical referrals and emergency evacuations when required, ensuring timely coordination and communication.
Monitor member benefit utilization and provide regular updates and insights to internal and external stakeholders.
Prepare and submit accurate and timely reports as required by management
and policy guidelines.
Review medical reports and laboratory results to assess clinical risk and provide recommendations to support underwriting decisions.
Qualifications
Bachelor’s Degree or Diploma in Nursing, Clinical Medicine or a healthcare-related field.
Experience
Minimum three (3) years of relevant experience.
Essential Knowledge and Skills
Strong understanding of medical care management and healthcare service delivery.
Ability to assess clinical risks through review of medical reports and laboratory results.
Excellent customer service and stakeholder management skills.
Strong communication, negotiation and coordination skills.
Ability to handle emergency medical cases professionally and efficiently.
Good reporting, analytical and problem-solving skills.
Ability to work effectively with healthcare providers, clients and internal teams.
How to apply
For more information and job application details, see; CIC Insurance Care Officer – Microinsurance Jobs in Kenya
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