Jubilee Insurance Care Manager Jobs in Kenya
Jubilee Insurance Care Manager Jobs in Kenya
Jubilee Insurance was established in August 1937, as the first locally incorporated Insurance Company based in Mombasa. Jubilee Insurance has spread its sphere of influence throughout the region to become the largest Composite insurer in East Africa, handling Life, Pensions, General and Medical Insurance. Today, Jubilee is the number one insurer in East Africa with over 450,000 clients.
Jubilee Insurance has a network of offices in Kenya, Uganda, Tanzania, Burundi and Mauritius. It is the only ISO certified insurance group listed on the three East Africa stock exchanges – The Nairobi Securities Exchange (NSE), Dar es Salaam Stock Exchange and Uganda Securities Exchange. Its regional offices are highly rated on leadership, quality and risk management and have been awarded an AAin Kenya and Uganda, and an A+ in Tanzania. For more information, visit www.JubileeInsurance.com.
We currently have an exciting career opportunity for a Care Manager within Jubilee Health Insurance Limited. The position holder will report to the Senior Care Manager and will be based at the Head office in Nairobi.
Role Purpose
The role holder will be responsible for visiting patients at the various service providers, providing professional guidance on policy matters, ensuring comfort and assistance of patient by the service provider, and communicating with providers, clients and brokers on a timely
basis for any rejections or relevant concerns.
Main Responsibilities
Obtaining daily reports of admissions in the various service providers
Broker/customer communications by communicating as necessary admission claim decisions on a timely basis
Care Management - Through due diligence, ensuring undertakings are issued in line with the policy provisions. Likewise for declines, ensuring that the decisions are accurate
Fraud mitigation – Implementing fraud mitigation strategy for the company.
Provider relationship management – Ensuring strong provider relationships to enhance provider and customer experience.
Visiting of patients at the various service providers, obtaining details of patients to confirm that admitted members are the eligible policy holders/ dependents.
Confirming that the treatment the member is given is covered by the policy purchased.
Ensuring that the medical reports in the hospital are accurate and reflective
of what is provided to the insurer and also confirm what the member understands or communicates.
Ensuring proper care and treatment of patient within acceptable protocols without wastage by member/ provider.
Reviewing medical pre-authorizations for compliance with applicable policy guidelines and giving guidance to the other care management team on any information collected during the visits to the hospitals.
Interacting with clients, brokers and clinicians as needed, to resolve problems in a manner that is legal, ethical and consistent with the principles of the policy.
Obtaining medical information from providers with written correspondence if necessary.
Checking and confirming membership validity and benefits (from the scheme benefits file).
Handling of coverage enquiries with brokers, providers, members.
Vetting and confirming validity of the service given by the service provider in relation to the benefits covered, treatment given, adherence to provider panel rules and cost of treatment.
Obtaining additional required information on claims from providers, brokers or clients.
Liaising with our underwriting section on scope of cover for various schemes.
Assisting in conducting provider audits wherever necessary.
Client presentations and member education on wise utilization & risk management.
Managing the 24-hour emergency helpline.
Key Competencies
Passionate, Goal driven and results oriented.
Strong organizational and analytical skills.
Strong Problem-solving skills.
Communication skills.
Team Spirit.
Strong interpersonal & relations skills.
Qualifications
Degree/ Diploma holders preferably in clinical studies (nursing).
University Graduate in a relevant field will be an added advantage.
Proficient in the use of Microsoft Office suite & packages (Word, Excel, PowerPoint and Vision).
Basic understanding of the concepts of insurance.
How to Apply
For more information and job application details, see; Jubilee Insurance Care Manager Jobs in Kenya
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