Reporting to the supervisor the role holder shall maintain constant contact with hospitals to ensure continuous well-being of all the stakeholders and handling of medical claims with efficiency and accuracy.
Key responsibilities
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Pre-authorise scheduled and non-scheduled admissions within the set guidelines
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Liaise with the hospitals and doctors for prompt submission of the admission summary form.
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Monitor procedures being carried out on patients and see to the general well being of the patient.
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Assess and authenticate inpatient and outpatient medical claim documents.
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Revise reserves after discharge of a member.
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Ensure smooth discharge process and coordinate any necessary post-hospitalization care.
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Visit health care Institutions in the assigned region to confirm admissions.
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Prompt collection of claims paid out of policy liability
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Process reimbursements within the stipulated time.
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Assist in carry out verification and medical audit of claims invoices before settlement.
Knowledge, experience and qualifications required
1. Diploma in Nursing
2. Basic understanding of insurance concepts
3. 1-2 years’ experience in case and claims management
3. 1-2 years’ experience in case and claims management
4.Professional qualification in ACII, IIK is an added advantage
Technical Competencies
1.Registered Nurse with Nursing Council of Kenya
2.Knowledge of case management processes and procedures
3.Knowledge of insurance regulatory requirements and concepts
4.Proficient in use of Microsoft office suites and packages.
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