Jubilee Insurance is searching for a Care Manager

• Name of the company : Jubilee Insurance
• Country : Nairobi, Kenya
• Job : Care Manager
• Required qualifications :
  • Visionary leadership, entrepreneur spirit, market awareness, customer focus, continuous innovation, ownership & commitment, team spirit
  • Performance reporting and management, accounting operations, health benefits plan management, policy reinsurance authorisation, intelligence and business development skills
  • Policy processing, database administration, exploitation and application of Information Technology, customer service
  • Graduate or form four leavers with a minimum of C+, diploma holders preferably in clinical studies, basic understanding of the concepts of insurance
  • At least 5 year relevant experience in a similar role
• Job description :
  • Undertaking of admissions (including declines)
  • 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
  • Reviewing medical pre-authorisations for compliance with applicable policy guidelines
  • 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
  • Participating in care management meetings
  • Checking and confirming membership validity and benefits (from the scheme benefits file)
  • Handling of coverage enquiries with brokers, providers, members etc
  • 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
  • Checking and confirming any advice by the registrar on any relevant information noted on inpatient claims
  • 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
• Offer available until : 6 February 2019
• Contact : Recruitment [at] jubileekenya [dot] com

Applications to be sent to quoting the Job Reference Number : HRJIC473