Assistant Risk Consultant - Care Coordinator at Zamara Kenya

Roles and responsibilities

Achieving Zamara’s ambitious strategic priorities will be complex and challenging. Its continued success will be dependent on building and retaining a world-class team.

The Assistant Risk Consultant, Care Coordinator will ascertain seamless service delivery to clients by offering support and assistance to medical insurance policy holders through the claims & call centre and at medical facilities, with minimal inconvenience, while supporting the overall goal of client satisfaction.

This role reports to the Senior Risk Consultant.

In more detail, the areas of responsibility include:

Care Management

• Receiving calls on the 24-hour medical emergencies help lines.
• Facilitate approval and authorization for Emergency Inpatient hospitalization e.g. post road traffic accidents from the insurance companies/underwriters
• Outpatient treatment authorization (off smart/ no card)
• Inpatient follow up with hospital visits
• Supporting members on chronic disease management
• Provider management
• Pre-authorization request processing and hospital procedure booking including maternity and theatre procedure bookings. Liaising with the Insurance companies in the process of undertaking and pre-authorizations.

Wellness

• Provide assistance in implementation of wellness programs set up for clients.
• Facilitate wellness events - wellness camps, sports day activities, staff team building events.
• Engaging various providers for wellness packages suitable to client needs.

Claims

• Adjudicating reimbursement claims for eligibility - member validity, within allowed timelines to avoid declines due to time barred claims, properly filled documents.
• Timely Logging in claim data into the system, for ease of management and reference.
• Following up for settlement of claims within agreed turnaround time

Value Adds

• Facilitation of admission and discharge processes for patients by securing all necessary documents and ensuring minimal participation by the patient during the admission or discharge
• Facilitation of special care for admitted patients e.g haircuts for executive clients at the bed side/ flowers
• Issuing Zamara gift packs - pack of diapers, branded get well / birth congratulations to admitted patients

Experience and personal qualities

• A Diploma in Nursing Sciences/ Clinical medicine
• Minimum of one (1) year working in a hospital set up/ health facility/medical insurance care department
• General understanding of the insurance industry is an added advantage
• Call centre management
• Capacity to build relationships
• Business etiquette
• Excellent interpersonal and customer service skills
• Team player
• Problem Solving skills
• Self-Driven
• Flexible to train