Stratostaff Health Insurance Care Analyst Jobs in Nairobi, Kenya

Stratostaff Health Insurance Care Analyst Jobs in Nairobi, Kenya

Profile Introduction

Our client, a leading financial and health insurance company seeks to bring on board a Care Analyst.

The role will be responsible for ensuring that the client customers receive affordable, accessible, cost effective and high quality health care services.

Key Areas of Responsibility

Maintain constant contact with hospitals to ensure continuous well-being of all the stakeholders and handling of medical claims with efficiency and accuracy.

Pre-authorise scheduled and non-scheduled admissions within the set guidelines

Liaise with the hospitals and doctors for prompt discharge plan of the admitted members.

Assess and authenticate inpatient and outpatient medical claim documents

Ensure smooth discharge process and co-ordinate any necessary post-hospitalisation care

Prescreening and vetting of inpatient, outpatient and reimbursements claims to ensure adherence to agreed tariffs and clinical protocols, with clear documented notes in case of decline and any discount offered by the providers

Conduct hospital visits and monitoring of inpatient bills

Daily monitoring of interim bills and appropriate interventions for high quality of care.

Daily status reporting of the clinical status of the admitted members.

Contact centre management, pre-authorization approvals on payments and responding to member and provider enquiries

Ensure timely notification to the stakeholder team of all the declined cases as per the policy guidelines.

Timely resolution of all the complaints

raised by clients.

Responding to all clients and providers requests within 24 hours

Ensure all counter guaranteed and roaming cases have official letters before approvals are done.

Authorization of maternity bookings and wellness letters are issued within 24hrs.

Monitoring client with chronic diseases by ensuring managed health care forms are completed by the doctors for proper follow up and management.

Health talks, wellness and check-ups management with providers and all stake holders

Ensure inculcation of the TCF (Treating Customers Fairly) culture

Minimum Qualifications:

Degree or Diploma in Medicine, Nursing, Clinical Officer or Pharmacy

2 years’ clinical experience

Core Competencies

Understanding of health insurance operations and concepts

Knowledge of medical claims processes and procedures

Stakeholder management

Customer service

Analytical skills

Interpersonal skills

How to Apply

If you are qualified and up to the challenge, please send your CV to vacancies@stratostaff.co.ke by 5 p.m, 27th March 2023.

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