Care Manager- FAK (Mombasa) at Absa Bank Limited

Job Summary

To perform all the case management roles both at the contact centre and back office, which includes but not limited to:

Job Description

• Sensitise and Provide information to clients about their policy guidelines.
• Continuously advise clients about the most cost-effective service options to Clients/Brokers/Agents/ company Human resource managers. 
• Facilitate for member sensitization and registration.
• Organize for hospital transfers and evacuations in reference to their policies.
• Calls managements in line with the international call centre standards.
• Organise and participate in Carrying out health forums for clients.
• Professional Handling of clients and service providers grievances within the stipulated time. 
• Managing requests for services from providers, intermediaries, and clients, providing information on the FAK provider network, available benefits per scheme policy and services and other routine information
• Respond to all emails and give feedback within one 30 minutes of receiving them.
• Critically analyse and give accurate response to all pre-authorization within the defined TATs and in line with member policy benefits.
• The care manager to accurately to decode prescriptions and other bills to identify any anomalies. 
• Negotiate with service providers for sustainable costs containment.
• Mitigate fraud cases through hospitals visitation of admitted patients in various hospitals, and vet all inpatient bills. 
• Ensure the service access turnaround time is within the stipulated Service Level agreement, Discharges within 30 minutes, outpatient responses within 10 minutes. 
• Sending daily admissions reports to clients; Brokers/Agents/ company Human resource managers. 
• Offer first aid to any emergency cases within/around First Assurance Office.
• Response to all escalations from the contact centre, carrying out customer surveys, social media and email management.
• Performs all other tasks as assigned by the Line manager.

Education Qualifications & Experience

• Bachelor’s degree or Diploma in nursing or clinical Medicine and Surgery
• Insurance Professional qualification
• Minimum of 3 - 4 years’ experience in a similar role in the insurance industry.