Skills Geographic

Care Manager -Medical Insurance (For a Private Medical Insurance Company)

Job Summary

Medical Insurance Care Manager will ensure full adherence to policy terms of all insurance products, compliance requirements and company policies

  • Minimum Qualification: Diploma
  • Experience Level: Mid level
  • Experience Length: 3 years

Job Description

Position: Care Manager -Medical Insurance (For a Private Medical Insurance Company)

Employer: A Leading Private Medical Insurance Company offering Local and International Healthcare Solutions)

Ref No: SGK-CM_MI-02-2020

Industry: Insurance

Job Category: Supervisory

Town: Nairobi

Country: Kenya


Qualifications:

Diploma or Degree in Medical, Insurance, Business Management or other related fields.


Experience:

At least 3 years hands-on working experience as a Care Manager managing the medical accounts of the registered members with the company


Responsibilities:
Care Manager -Medical Insurance will perform the following duties:-

  • Full adherence to policy terms of all insurance products, compliance requirements and company policies.
  • Pre-authorize scheduled admissions/day cases within the set guidelines/TATs in liaison with Aetna.
  • Assist in evacuations for emergency treatments.
  • Liaise with Doctors on the day to day management of patients and obtain medical reports/ expected length of stay where indicated as well as discharge planning.
  • Respond to queries from clients, intermediaries and service providers on preauthorization procedure.
  • Liaise with providers to obtain cost estimates for planned procedures as applicable.
  • Timely GOP placement to ensure smooth discharge process and co-ordinate any necessary post-hospitalization care.
  • Develop and maintain monthly database on all admissions.
  • Participate in member education including but not limited to wellness, benefits etc
  • Promote process improvement and automation activities to maximize efficiency and accuracy.
  • Active client engagement including but not limited to hospital visits.
  • Liaise with claims and network teams to flag and prevent fraud.



Expected Salary:- Kshs. 80,000 - 100,000 plus generous benefits

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