Nurse at Britam

Overall Job purpose

Reporting to the care supervisor the role holder shall maintain constant contact with hospitals to ensure continuous well-being of all the stake-holders and handling of medical claims with efficiency and accuracy.

Key Responsibilities

• Pre-authorise 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 wellbeing 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-hospitalisation 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 24hr helpline.

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 avantage

Technical Competencies

• Registered Nurse with Nursing Council of Kenya
• Knowledge of case management processes and procedures
• Knowledge of insurance regulatory requirements and concepts
• Proficient in use of Microsoft office suites and packages

Essential Competencies

• Learning & Researching
• Working with people
• Applying Expertise and Technology
• Delivering Results and Meeting customer expectations
• Following instructions & Procedures
• Adhering to principles and values

Desirable Competencies

• Achieving personal work goals and objectives
• Writing and Reporting
• Analysing
• Planning & Organizing
• Adapting and responding to change
• Coping with pressures and setbacks