Senior Case Management Officer at Britam

Job Purpose:

• Supervising Health Care processes and procedures through the use of effective techniques to achieve the objectives of cost, quality control and operational efficiency.

Key responsibilities:

• Ensure quality & affordable care to all admitted patients.
• Analysis and interpretation of admission, savings and average cost reports for effective cost control.
• Enrolment of members to CDM program and follow up.
• Work with the wellness team to ensure compliance.
• Verification and audit of outpatient and inpatient approval requests as per the claims manual and customer service charter manual to ensure compliance and mitigate risk.
• Supervise; train and mentor case management officers to achieve a high level of motivation and productivity by the team.
• Negotiate professional fees and hospital charges including discounts to control expenditure.
• Hold regular business meetings with service providers to ensure compliance on contract terms, use of agreed systems and agreed tariffs.
• Monitor, prevent and control medical claims fraud by carrying out regular audits on the internal and external systems/ processes as well as providers.
• Prepare regular care reports to clients, management and advice medical underwriting section on relevant care findings for medical risk review.
• Delegated Authority:  As per the approved Delegated Authority Matrix.

Key Performance Measures:

• As described in your Personal Scorecard.

Knowledge, experience and qualifications required

• Diploma/Degree in Nursing or Diploma in clinical medicine or Diploma in Pharmacy.
• Professional qualification in Insurance (ACII, FLMI or IIK) – added advantage.
• 6-8 years’ experience in medical claims handling two of which should be in a supervisory position in a busy insurance office.
• Knowledge of insurance concepts.

Technical/ Functional competencies:

• Knowledge of insurance regulatory requirements.
• Knowledge of insurance products.
• Sales and marketing management skills.

Leadership category responsibility framework (Core Competencies):
Team Leaders in Britam need to:

• Operationally lead a team to service customers from a sustainable and growing customer base whilst increasing profit.
• Ensure the company’s objectives are met by being a vision carrier and by implementing strategy and operational outputs.
• Effectively run the business and manage staff in order to enable functional leaders to focus on developing strategy.
• Effectively identify and define key performance areas, deadlines and goals for their team in order to optimise operational effectiveness.
• Ensure the department has the most appropriate people capability through effective inspirational leadership, people development, effective selection and optimised succession planning.
• Create a high performance, proactive culture and motivated team.
• Monitor operational implementation, budgets, plans, goals and outputs in order to ensure alignment with the departmental strategy.
• Ensure that department priorities are adhered to and effectively communicated.
• Effectively disseminate knowledge within the correct context, towards subordinates as well as management.
• Appropriately model the company values while setting the pace and energy for delivering.
• Benchmark operational activities internally as well as externally in order to be a leader in the industry.
• Effectively manage and communicate change within the department in order to increase staff and process effectiveness.
• Provide access to accurate and consistent information and services across all channels.
• Adequately manage operational risk.