Current Job Openings at PACIS Insurance

JOB PURPOSE

The jobholder is responsible for the assessment and determining terms for medical risks.

PRINCIPAL ACCOUNTABILITIES

Underwriting Role

• Assess the new and existing risks and ensure that they are adequately rated and commensurate with the terms and conditions advised and endorsed to retain profitability of the medical portfolio.
• Provide competitive quotations to all customers promptly within the standards set.
• Membership management; additions and cancellations.
• Scheme set up, benefits set up and membership updates in the system
• Timely and accurate debiting of premium and cover conditions and that the documentation is in compliance with set standards and procedures.
• Ensure that medical insurance cards are issued in an efficient timely and accurate manner
• Prepare and send renewal notice within stipulated timeline and co-ordinate follow up of the renewals to achieve renewal capture targets.
• Ensure policy endorsements & documents are accurate and made within the standards of service, and ensure timely dispatch
• Train various stakeholders on company products for increased knowledge and growth of business
• Monitor scheme loss ratios and adjust renewal terms accordingly
• Assist with business acquisition through follow up on quotes and intermediary visits.
• Ensure business is booked as per the company’s credit policy and follow up on payment plans.

Customer Service Role

• Continuously monitor the outpatient fund and check on prudent utilization of cover reporting any anomaly noted and ensure timely invoicing for top up.
• Provide benefit utilization reports as per the standards of service set out in the customer charter
• Provide timely feedback to client’s queries and concern as per service charter provisions.
• Maintain client and intermediary relationships through visits

KNOWLEDGE AND EXPERIENCE

Qualifications:

Minimum Academic Qualifications

• A Bachelor’s degree in Actuarial science/Statistics from a recognized University.

Professional Qualifications

• Diploma in Insurance

Experience:

• Entry Level to 6 months of experience.

SKILLS AND COMPETENCIES

• Stakeholder Management
• Analytical skills
• Teamwork
• Interpersonal and communication skills
• Accuracy/Keen to detail
• Commitment & dedication
• Decision making
• Customer oriented
• Planning and organization skills

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PURPOSE OF THE JOB:

Collaborate with medical clients, intermediaries, and medical service providers to facilitate access to quality, timely, effective, and cost-efficient healthcare services with the aim of achieving business growth, profitability, and customer retention.

PRINCIPAL ACCOUNTABILITIES

Claims Processing

• Confirmation of membership, validity, and benefits before processing claims.
• Capture and vet medical bills within the clients benefit structure.
• Code, verify, audit and process medical claims within negotiated, customary and reasonable price.
• Correctly reserve bills on discharge and approved outpatient cases.
• Provide second review of bills where providers question the appropriateness of payment authorized.

Care Management

• Review pre-authorization of admission, discharges, scheduled and emergency medical cases, issue timely responses as per policy benefits and company guidelines.
• Review of patient’s history and records to determine cause of disease and assess if treatment correlates with the diagnosis and applicable benefits.
• Coordinate local and international emergency evacuations, referrals, and transfers
• Set the appropriate parameters for each admission (claim reserve, initial authorized cost and duration) and ensure their compliance.
• Negotiation of doctors’ and hospital bills and charges in view of reducing the cost of care before or during admissions.
• Visit patients admitted within Nairobi and follow up the ones admitted outside Nairobi. Post discharge follow up of patients to ensure adherence to care.
• Follow up care of admitted patients with the doctors and providers to ensure quality care and cost containment.
• Implement preventive care program through health talks, wellness and the chronic disease management program CDMP.
• Send weekly and monthly report on admissions, exceptional claims, long stay, savings amongst others.
• Audit service provider applications, process contracts and provider feedback

Customer Service

• Oversee weekly sending out active members list to the providers.
• Update intermediaries and/ or scheme administrators on clinical, coverage and bills of admitted clients.
• Provide feedback and update to intermediaries and schemes on requested providers.
• Coordinate with the clients and medical providers to leverage on NHIF.
• Ensure adherence to contracts and service level agreements between providers and the company.
• Process reimbursement documents and communicate to clients about the status of their claims.
• Register, follow through and resolve the customers and provider queries and complains in time and advise them on outcome and the details of the medical product.

KNOWLEDGE AND EXPERIENCE

Qualifications:

Academic Qualification

• Bachelor’s degree Nursing/ Diploma in Nursing

Professional Qualifications

• Nursing Council of Kenya
• AIIK

Experience:

• Four years’ experience in health insurance

Knowledge

• Understanding of insurance industry

SKILLS AND COMPETENCIES

• Excellent communication and Interpersonal Skills.
• Problem Solving
• Empathy
• Decision Making
• Negotiation Skills
• Ethical
• Team Player
• Keen to detail
• Planning & Organization Skills
• Customer Oriented
• Stakeholder management
• Dependability