Britam is a leading diversified financial services group, listed on the Nairobi Securities Exchange. The group has interests across the Eastern and Southern Africa region. The company offers a wide range of financial products and services in Insurance, Asset management, Banking and Property. The product range includes: life, health and general insurance, pensions, unit trusts, investment planning, wealth management, off-shore investments, retirement planning, discretionary portfolio management, Property development and private Equity.
Job purpose
Maintaining constant contact with hospitals to ensure continuous well-being of all the stakeholders and handling of medical claims with efficiency and accuracy.
Key responsibilities
- Pre-authorize scheduled and non-scheduled admissions within the set guidelines
- Liaise with the hospitals and doctors for prompt submission of the admission summary form
- Monitor procedures being carried out on patients and see to the general well being of the patient
- Assess and authenticate inpatient and outpatient medical claim documents
- Revise reserves after discharge of a member
- Ensure smooth discharge process and co-ordinate any necessary post-hospitalization care
- Visit health care Institutions in the assigned region to confirm admissions.
- Prompt collection of claims paid out of policy liability
- Process reimbursements within the stipulated time
- Assist in carrying out verification and medical audit of claims invoices before settlement
- Handling of the 24 hour helpline.
Key Performance Measures
- % Claims turnaround time
- % customer complaints resolved within SLA
- # of customers engaged in awareness training
- Customer satisfaction index
- Net promoter score (Customers)
Knowledge, Experience And Qualifications Required
- Diploma in Nursing
- Basic understanding of insurance concepts
- 3.1-2 years’ experience in case and claims management
- Professional qualification in ACII, IIK is an added advantage.
Competencies
- Knowledge of insurance concepts
- Knowledge of case management processes and procedures
- Knowledge of insurance regulatory requirements
Core competencies
- Good Communication skills
- Building Relationships
- Focuses on the Customers
- Develops Self
- Solves Problems
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