KEY TASKS AND RESPONSIBILITIES
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 environ
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
SKILLS AND COMPETENCIES
Excellent communication and negotiation skills
Excellent public relations and interpersonal relationship skills
Extensive networking with SP and other medical insurers
Excellent analytical and monitoring skills
Good IT skills in database management and office systems
Good decision making in benefit utilization management
High levels of integrity and honesty
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