Careers at Old Mutual Kenya

PRINCIPAL ACCOUNTABILITIES

• Claims Cost Management: Develop and implement internal and external strategies to address claims costs.
• Case Management: Oversee the case management process, ensuring efficient and effective handling of claims from initiation to resolution.
• Claims Processing: Develop and implement strategies to streamline claims processing, reducing turnaround times and improving accuracy.
• Provider Onboarding: Manage the onboarding and provider audit process for healthcare providers, ensuring they meet all necessary qualifications and are integrated smoothly into the network. Providing oversight on provider discount negotiations.
• Claims Quality Assurance: Implement quality assurance programs to monitor and improve the accuracy and consistency of claims processing.
• Data Analysis: Analyze claims and case management data to identify trends, areas for improvement, and opportunities for cost savings.
• Team Leadership: Lead and develop a team of clinical operations staff, providing training, support, and performance evaluations to  meet overall business strategic objectives
• Stakeholder Collaboration: Collaborate with internal and external stakeholders, including healthcare providers, regulatory bodies, and insurance partners, to ensure seamless operations and cost management.
• Strategic Planning: Develop and implement strategic plans to enhance clinical operations and achieve organizational goals.
• Automations: Deliver technology automations that will address operational gaps affecting clinical teams.

SKILLS/QUALIFICATIONS:

• Bachelor's degree in Healthcare Administration, Nursing, or a related field
• Minimum of 5 years of experience in clinical operations, claims processing, or a related field
• Relevant certifications in healthcare management or clinical operations are preferred
• Strong leadership skills with the ability to inspire and motivate a team
• Excellent analytical skills to interpret data and make informed decisions.
• Exceptional communication skills for effective collaboration and stakeholder management.
• Strong problem-solving abilities to address and resolve operational challenges.
• High attention to detail to ensure accuracy and compliance in all operations.
• In-depth knowledge of healthcare operations, claims processing, and regulatory requirements.

PERSONAL ATTRIBUTES 

• Good communication skills
• Knowledge of medical insurance
• Good people skills
• Diplomacy and tact
• Honesty and integrity
• Good assessment and analytical skills
• Ability to work with cross functional teams
• Ability to meet strict deadlines
• Ability to interact at all levels

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Duties:

• Spearhead enhancements and innovation within the business in relation to processes and systems
• Address cross-functional and interdepartmental process inefficiencies to ensure delivery of superior service to both internal and external customers.
• Track and report on Telephone Efficiency for the business with the objective of improve the response time
• Complaints Management – Ensure all complaints are logged in CRM, tracked and resolved within the stipulated timelines as per the complaints management policy
• Track all customer touch points for the business and address the root causes to ensure superior and differentiated customer experience
• Visit customers, intermediaries and branches periodically with the focus on identifying emerging service issues, root causing and implement improvements to address the gaps
• Timely issuance of the management reports in respect to customer touch points, which include but not limited to Complaints, Service meetings, NPS/NES, Complaints, processing TATs
• Continuously improve processes by reviewing them periodically and automating routine processes
• Maintain and update processes manual for the department from Level 1 to 5 including SOPs
• Ensure compliance to DPA and AML business requirements
• Ensure 100% compliance to existing business processing controls

Skills/Qualifications:

• Bachelor’s degree in the relevant field
• Progressing to ACII Qualification
• 5 years in medical insurance underwriting and operations functions
• Demonstrate interest in attaining professional insurance qualification
• Good spoken and written communication skills
• Strong analytical and reporting skills
• Strong skills with Microsoft Office Package: Excel, PowerPoint and Outlook

PERSONAL ATTRIBUTES             

• Good communication skills
• Knowledge in medical risk assessment.
• Good people skills
• Diplomacy and tact
• Honesty and integrity
• Good assessment and analytical skills
• Ability to work with cross functional teams
• Ability to meet strict deadlines
• Ability to interact at all levels