Careers at Britam

Job Purpose:

• Controlling and Managing policies through case management to ensure quality and cost effective healthcare, client service, provider management, processing provider claims and clients for payment.

Key Responsibilities:

• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration).
• Interact with clients and service providers to ensure that the care is given within policy guidelines.
• Review medical reports and claims for compliance with set guidelines.
• Process claims and claims vetting.
• Liaise with underwriters on scope of cover for the various schemes.
• Ensure that medical scheme members are attended to round the clock with support from 24 hour call centre.
• Discourage poly-pharmacy by diligently challenging of prescriptions and suggesting better alternatives as per medical practice.
• Encourage use of generics and cost effective quality drugs where indicated as a method of reducing the organizations pharmaceutical expenditure.
• Review documents and pertinent requirements regarding claims from providers and clients.
• Ensure that the claim made by the claimant is complete in form and complies with the documentary requirements of an insurance claim.
• Management of relationships with clients, intermediaries and service providers.
• Verification and audit of outpatient and inpatient claims to ensure compliance and mitigate risk.
• Advice claimants regarding basic matters about their insurance coverage in relation to the insurance claim.
• Respond to both internal and external claims inquiries concerning claims process, service providers, and the filing/completion of proper forms.
• Record all claims transactions. 
• Prepare claims registers for claims meetings and update the various claims reports.
• Track and follow up on receipt of necessary documents.
• Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, experience and qualifications required

• Degree in Bachelor of Science in Nursing Sciences from a recognized university.
• Professional Nursing qualification KRCHN licensed by Nursing council of Kenya.
• At least two-year experience in case management and claims processing.

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Job Purpose:

• To identify business requirements and develop solutions (database design, workflows, user/data interfaces, integrations) and design, development, and 2nd line support of business Applications, ranging from user analysis, design, and development to implementation and maintenance.

Key Responsibilities:

• Configure and/or customize business applications to meet business requirements using various  database and software tools.
• Assist in presentations of system functionality to new users and departments. Drives systems  adoption by business users.
• Enhance and create user and system documentation as needed.
• Work directly with the IT support personnel and teams to resolve issues identified and escalated during daily operations.
• Perform the necessary technical design and development functionality to ensure that business  application systems can be effectively developed and implemented.
• Design and development of front-end tier(s), middle tier(s), and /or back-end database tier(s) for business applications.
• Capturing of business applications information needs and mapping of the same to the software  and /or database components.
• Perform data modelling to analyze and specify data structures within an application system.
• Developing database objects and structures for data storage, retrieval and reporting according to specifications.
• Implementing and testing database design and functionality and tuning for performance.
• Research and provide input on design approach, performance and base functionality 
  improvements for various procedures and applications.
• Generation of ideas to improve efficiency in software and application services offered to the  business, and/or generate revenue for business.
• Delegated Authority: As per the approved Delegated Authority Matrix.

Knowledge, experience and qualifications required

Qualifications & Experience:

• Degree in Computer Science or a technical-related field.
• 4 – 6 years experience in applications development, which includes system customization, 
  support and report designs.
• 2 years’ experience with RDMS preferably MS SQL Server, Oracle and MySQL.
• Certified in IT. 
• Know data analysis and analytics, Mobile infrastructure, Internet technologies, e-commerce and e-payment technologies.
• Experience in process automation using robotics.
• Previous experience in a financial/insurance institution will be an added advantage. 
• Membership to relevant IT bodies.