Heritage Insurance Head of Claims and Care Management Jobs in Nairobi, Kenya
Heritage Insurance Head of Claims and Care Management Jobs in Nairobi, KenyaHeritage Insurance CompanyJob Title: Head of Claims and Care Management
Director – Health Insurance
Head Office, Nairobi
We are a leading Insurance Company, affiliated to Liberty Group, a wealth management company represented in 18 African countries.
We use our knowledge and action to guide our customers on their journey to financial freedom.
We believe in responding to the changing consumer and market needs through innovative solutions and technologically efficient processes.
The main purpose of the job is to ensure that Heritage customers receive quality healthcare at an affordable price and to oversee the activities relating to medical claims settlement.
Claims Management:Develop the claims management strategy for health business that ensures medical claims management contributes to the profitability of the business
Develop policies and procedures that guide the delivery of medical claims management services to support profitability and compliance with the relevant insurance regulations
Develop processes for claims management to support efficiency and effectiveness in delivering quality customer service in line with the Heritage values
Co-ordinate and maintain expeditious and efficient processing of medical claims and ensure customer needs are attended to promptly
Review claims processed to ensure that all claims fall within scope of respective medical insurance policy and are in compliance with Heritage claims management policies and procedures, and to ensure only qualified medical claims are paid out.
Monitor the trends in the claims submitted for analysis against those paid in order to develop a strategy that advises the business on how to organize claims management in support of profitability
Develop and implement a records management plan for claims management including automation to ensure ease in availability and accessibility of claims management records for timely service delivery;
Conduct a regular review of the claims process to identify gaps to be addressed in order to enhance profitability as well as efficiency and effectiveness in the claims management process
Attend to escalated and complex medical claims to ensure these are attended to in a timely manner, and that they do not expose the business to any risk;
Analyse medical claims data to identify issues, and ensure that all relevant issues relating to underwriting policies and product pricing are identified and communicated to relevant stakeholders.
Care ManagementEnhance customer experience – Establish and maintain good relationships with internal and external stakeholders such as health care service providers, brokers, agents and policy holders etc. Source analyze and provide relevant management information as required to appropriate parties for effective and efficient decision making.
Digitize our processes for provision of member information requirements that include health tips.
Ensure inculcation of the TCF (Treating Customers Fairly) culture.
Develop a preventive care program through health talks, wellness programme that is a key component of our value proposition and Chronic Disease management.
Incentivize the insured to maintain performance at the target MLR per product.
Monitor existing scheme performance to achieve medical loss ratio of 75% on Flexi & 66% on Blue Class
Develop and maintain thorough pre-authorization and care management processes to ensure accurate decisions on levels of care and the provision of appropriate treatment to patients.
Provider management – Develop and maintain an efficient and effective health provider network that delivers access to a healthcare service that is affordable and appropriate.
Contact centre management – Ensure that the medical contact center is effectively managed by ensuring that all responses to clients are professional, accurate and timely including prompt and efficient handling of all calls outside the Contact Centre hours.
People ManagementDevelop staff members by sharing knowledge, mentoring, coaching and training and to ensure full range of performance management processes and procedures.
Degree or Diploma in Medicine, Nursing, Clinical Officer or Pharmacy
Professional qualification in Insurance (AIIK or ACII) will be an added advantage
7 years in health insurance operations 3 of which must be in a managerial role
Knowledge of insurance industry and concepts
Customer, market and competitor understanding
Knowledge of insurance regulatory requirements
Formulation of strategies and concepts
Business management skills
Strong personality with interpersonal sensitivity
Quality decision making skills
Conflict handling skills
Good written and verbal communication skills
Strong negotiation skills
Creative & open-minded
High level of numeracy and strong analytical skills
How to Apply
If you meet the above requirements you are encouraged to forward your application and updated CV to firstname.lastname@example.org by 14th April, 2019.
Clearly state the job title on the subject heading.
Heritage is an equal opportunity employer and actively encourages diversity.
Please note that only shortlisted candidates will be contacted.
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