Assistant Case Manager at PACIS Insurance

PURPOSE OF THE JOB

• Provide superior customer experience by efficiently and effectively managing clients and medical provider requests, queries and enquiries.
• To process medical claims submitted to the company and determine whether claims meet eligibility standard of the company.

KEY RESPONSIBILITIES

Claims Processing

•  Confirmation of membership, validity, and benefits before processing claims.
•  Capture and vet medical bills within the client’s benefit structure and as per negotiated customary, reasonable rates.
•  Correctly reserve bills on discharge and approved outpatient cases.
•  Preparing and sending of the correct remittances to clients.

Case Management and Customer Service

•  Receive and respond to medical emergency lines and ensure 24-hour coverage.
•  Handle phone calls and visitors, as well as resolve customers’ communication through electronic and physical channels.
•  Issuance of both inpatient and outpatient approvals for admissible requests for insured members.
•  Communication and notification to stakeholders on management of cases, discharges, admissions, and financial liability
•  Coordinate with the clients and medical providers to leverage on NHIF.
•  Negotiation of doctors’ and hospital bills and charges with the aim of reducing the cost of care before or during admissions.
•  Weekly running and sending out active members list to preferred panel of providers.
•  Assist in coordinating local and international emergency evacuations, referrals, and transfers.
•  Visit patients admitted within Nairobi and follow up the ones admitted outside Nairobi.
•  Send weekly and monthly reports on admissions, exceptional claims, long stay, savings, claims production amongst others.

KNOWLEDGE AND EXPERIENCE
Qualifications:
Academic Qualifications

•  Bachelor’s degree Nursing/ Diploma in Nursing /
• Clinical Medicine.

Professional Qualifications

•  Nursing Council of Kenya
•  Clinical officer Council
•  AIIK or Certificate of Proficiency will be an added advantage.

Experience

•  At least one year experience in health insurance

Knowledge

•  Understanding of insurance industry

SKILLS AND COMPETENCIES

•  Excellent communication and Interpersonal Skills.
•  Problem Solving
•  Empathy
•  Negotiation Skills
•  Ethical
•  Team Player
•  Planning & Organization Skills
•  Customer Oriented
•  Dependability