Closing: Jul 12, 2024
Closing todayPublished: Jul 4, 2024 (9 days ago)
Job Requirements
Education:
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Work experience:
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Language skills:
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Job Summary
Contract Type:
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QUALIFICATIONS, KNOWLEDGE & EXPERIENCE
- Diploma or Degree in Nursing
- Diploma in Insurance/ COP
- Degree in Health systems Management/ Business management
- 3 years’ experience in clinical setting +2 years in insurance set up
Responsibilities
QUALIFICATIONS, KNOWLEDGE & EXPERIENCE
- Diploma or Degree in Nursing
- Diploma in Insurance/ COP
- Degree in Health systems Management/ Business management
- 3 years’ experience in clinical setting +2 years in insurance set up
- Pre-authorize scheduled and non-scheduled admissions within the set guidelines.
- Negotiate/discuss professional fees as appropriate for each admission.
- Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
- Visit all admitted clients within Nairobi region and its environs
- Liaise with Doctors on the day-to-day management of patients and obtain medical reports/ expected length of stay where indicated.
- Ensure smooth discharge process and co-ordinate any necessary post-hospitalization/ step down facility care.
- Revise reserves after discharge of member.
- Collect feedback from admitted clients on quality and scope of service by the service provider.
- Assist in carrying out verification and medical audit of claims/invoices before settlement.
- Develop and maintain monthly database on admissions, large claims and extended length of stay.
- Respond to queries from clients, intermediaries and service providers.
- Liaise with other medical underwriter for purposes of market surveys and development of new controls, standards and products.
- Any other duty assigned by management.
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